WHCC: Wiring the nation

David Brailer gave an update on standards, government process. No one in charge means no standards….now we’ve got them and that will give the private industry a basis to build from.

Robbie Pearl, Permanente Medical Group— We need to change the financing of care. Technology gives us the option, but I think that we’re going piece-meal and may miss the opportunity.

Glen Steele, Geisenger—If you get paid piece work then you’ll design your system to fit that. Once you get that forcing function then you need the data. Also got to have the culture where the providers think about the common good. That has to be there before the EMR will magically do what everyone thinks that it’s going to do. They’re experimenting with reaching out to non-Geisenger physicians to see if they can provide them with EMRs via a portal.

Brailer—Can’t legislate good will. Mandates are not off the table, but all we can do is force doctors to put in technology. If we just try to mandate it, it doesn’t lead to the process change that we need. Plus what we mandate will not be compatible with what they’ve already got in place. Secondly. small practices couldn’t deal with an imposition. Thirdly, standards in HIPAA were factually incorrect and cannot be kept up to date. Government action cannot be the answer to a technologically evolving situation. When we get to 65–70% adoption then there’ll be a mandate then. Mandates don’t work on the front end of an adoption curve.

Steele—perhaps we should think that HIT is non proprietary, should it be like the Interstate highway.

Pearl—technology is not the issue-it will keep getting better. The key issue is transformation of care. 20–30 years ago patients had episodic disease. Now chronic care that needs constant supervision and can be solved by technology easily, so long as the care is transformed.

Brailer—Now about a year away from figuring out what is and isn’t happening. We do have a lot to learn from other countries. Already spending $20bn a year on health IT in US.  We should learn from them and make sure that we don’t block their future development. Most of those countries are actively buying technology.

Audience Poll results—biggest barrier to IT adoption? 34% standards, 25% no incentive, 20% inadequate support for implementation.

Steele—we need to pay for results to move this adoption very quickly.

Pearl—Health care cannot be practiced in high quality without these IT systems. there is a cost involved but there is a cost in all care. The overall issue is to change overall care and seize the moment.


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  1. These knee-jerk, anti-mandate folks really tick me off. Brailer: “Mandates don’t work on the front end of an adoption curve.” He lost me when he spouted off that whole paragraph.
    Ummm, air bags in cars, anyone? The automakers got dragged kicking and screaming into it. Government mandated passive restraints. Then Iacocca figured that if you put air bags in every car line, instead of just the Cadillacs and Lincolns, that was a value-add. No further mandates were needed. Now the automakers are fighting each other to see who has the best and most air bags (second-generation, side curtain, etc.) in their cars, and safety crash test results are a major selling point. No one is mandating the continued improvements. The market is driving them.
    Now, sure, it has driven up the cost of purchasing a car to put in these safety features, but the smart companies have found a way to decrease that per-unit cost over time. That’s competition, folks. Adjusted for inflation, purchasing a car today costs less than it did before the passive-restraints mandate, and there’s no argument against it: the mandate made them a better product.
    Or would the purist libertarians like to argue that we ought to have the choice of a car without airbags, or for that matter, safety belts, which had to be mandated in the 1960s as well?
    The beginning of the adoption curve is the BEST place for mandates. If they’re done right, markets will assure you won’t need them later.

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