Heroic Intervention Not Required
This is my first blog after a long absence. My reticence has been mainly self-inflicted. I like to find the humor in how seriously the technology industry takes itself, and how ironically that often plays out in the world of healthcare information systems, and then insert hot skewers in the appropriate soft spots. The problem of late is that the HCIS space isn’t generating a lot of funny material. Here in the USA, our entire industry has been trying to embrace the opportunity afforded by our taxpayer-debt-funded quasi-recovery aka ARRA and the Meaningful Use metrics that govern the presence/absence/size of a “reward check.” Is that 3 Red-White & Blue 7’s on the ARRA slot machine or a couple of Cherries on the 5th pay line? Is it meaningful when Bob from Newark logs into the Patient Portal and looks at an A1C number under the watchful eyes of the discharge nurse? Is it meaningful when the vendor rep drives away in her new Lexus? Does it move the needle on quality of care when another independent doctor’s practice is dissolved by pressures of the regulatory environment and subsumed into the healthcare megaplex? Like Don Henley, “I’m trying to get down, to the heart of the matter, but my will gets weak, and my thoughts seem to scatter….”
And then I snap out of my 3 years of government-induced reverie and get back to the question at hand – what do we want our HCIS systems to do? The old mantra I came to know and love after listening to many of you for a very long time is that for an IT initiative to be “worthy” in healthcare it needed to either: a) improve patient care and safety; b) improve the efficiency and workstyle of physicians and clinicians so they would regain patient-facing minutes; or c) reduce the cost of delivering quality care; or ideally d) all of the above. Those were the things we were all thinking about in early 2007, right before the economic bubble burst and refocused us on priorities whose long-term value and “meaningfulness” remains somewhat debatable. Whether for good or ill, we have emerged from the last 6 years more reliant on the technology than ever. We can’t get our most expensive ICD codes reimbursed without electronic documentation. We can’t order on paper in a lot of facilities. Recent grads don’t know how to look up drug interactions in the gigantic book the printer now sits on top of at the nursing station. Downtime is no longer an inconvenience, it is an unacceptable, go-directly-to-DEFCON 5 event. It removes fluid communication from the patient care process. It cancels vacations and calls in extra staff. It sets up a perimeter watch for the local news media.
So, if that’s all true, why are we still building systems with multiple SPOFs (single points of failure)? Why do we insist on cool technology when we need sustainable technology? The generation of field engineers I have been privileged to share a career track with across 4 companies have all taken their turns at swinging in off a wayward construction crane like some kind of IT Spiderman to put out a fire, but since I’m quoting pop icons anyway, how about a little Billy Joel?: “We didn’t start the fire, it was always burning since the world’s been turning. We didn’t start the fire. No we didn’t light it but we tried to fight it.” And like Bruce-Willis-arisen from the primordial wreck of yet another evil terrorist plot we are all “getting too old for this $%#&”.
Middle age isn’t really when you buy the Red Porsche and slide off the rails of sensible behavior. Middle age is when you have more friends and family in the next life then you do in the present one. It is the time when a well-formed conscience starts to have a healthy concern for the legacy it is leaving. It is the beginning of wisdom. I am watching a generation of leaders in the companies I grew up with start to think about those things, and all in all, I think it’s healthy. Expect some pleasant surprises in the next few years as your favorite technology solutions evolve. And if you invite me in to scribble pictures on your whiteboard, expect a discussion about sustainability shortly after we frame the latest craze in its right context.
Jim Fitzgerald is Executive Vice-President of Park Place International.