Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?
Not so fast, says Rob Kolodner (director of ONCHIT) who (writing
with Simon Cohn & Charles Friedman) says that on the four core
measures of adoption, governance, privacy and security, and
interoperability, real progress has been made in four years.
And they call it a foundation, even if no tipping point has yet been
reached. Of course, what they cannot say is what they’d do it if there
were any federal money available for the effort. Obama’s plan says that
there’ll be $10 billion a year for health IT. Right now ONCHIT’s budget
can barely buy coffee for Kolodner and his staff.
Finally, David Kibbe (yup, Health 2.0’s friend) and Curtis
McLaughlin (adjunct proffessor of business at UNC Chapel Hill) accuse
federal health IT policy of being the drunk looking under the lamp post
for the keys. Out in the dark are all the “unmentionable” Web-based tools and services that have transformed other industries, and there is clearly plenty of work going on it that sphere right now in health care.
But instead the Health IT standards are being set by representatives
of the big health IT vendors and the providers they work for. None of
them are particularly interested in interoperability or data
transference — as the potential efficiency of those concepts bring
reduces their potential revenue. After all the vendors make lots of
money building one-off interfaces between systems for their clients,
and the providers from doing unnecessary test and procedures.
They also perceive data fungibility as leading to direct competitive threats, and they are right to do so. If I can easily move my data to anywhere, why would I stick with opinions from my local providers and not move it to say, the Cleveland Clinic, Johns Hokpins or Partner’s online service? And if Google or Microsoft or an open source solution can provide 80 to 90 percent of the efficacy of a Cerner (and no they’re not there yet), Cerner is right to be worried.
Of course, as everyone knows and only Kolodner doesn’t say (because he can’t) there are only two solutions.
Either we reform the financing system (a la Enthoven or Holland) so that health care organizations compete on who can deliver population health most efficiently. Then they’ll start changing their processes and using the technology that other corporations are using to do that, or they’ll be chased out by competitors who do.
Or, we do what everyone else in the world has done, and accept that the current health system is what we have to work with, and that we aren’t prepared to see that type of market dislocation. Instead, we have the government fund the necessary changes in IT, and insist that all those in the system use it. By the way, this socialist diktak is Newt Gingrich’s preferred solution.
Neither of these solutions precludes the Health 2.0 solutions and technology advances that David advocates. In fact they both would make them more likely to be successful. But as ever (and as maybe Porter and Teisberg might one day discover) incentives come first.
And of course, I’d be remiss in my shameless marketing duties if I did not point out that Clay Shirky, Carol Diamond, Rob Kolodner and David Kibbe will all be at the Health 2.0 Conference to pick up on this conversation!
Categories: Matthew Holt