If you're a fan of the musician Sting, you're probably familiar with the line, "History will teach us nothing," from the song of the same name. You might at first think the song suggests that we can't learn anything from the past. But a closer listen suggests Sting's point is that history will teach us nothing if we don't pay attention to it.

That's where health IT is right now: Poised at a historical crossroad where it can either ignore past mistakes made by other technology-driven industries or profit from them.

The point was driven home in a recent New England Journal of Medicine editorial penned by Spenser S. Jones from the Rand Corp. and several colleagues from Rand and Harvard Medical School.

They discuss how in the early 20th century, many U.S. manufacturers thought that moving from waterwheels and steam engines to electric motors would make their factories more productive and profitable. Initially, it didn't work because management simply "pasted" the new technology into the existing infrastructure. That infrastructure required the use of inefficient belt-and-pulley systems to move power from a huge centrally located electric engine to all the devices that needed it.

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The real productivity boost came when management realized the best approach was to place several small motors throughout a factory to generate power on a case-by-case basis. Put another way, the technology improved productivity only after managers saw the need for process re-engineering.

Sound familiar? In healthcare today, we're seeing many clinicians give up paper recordkeeping systems by patching in EHRs. Then they're frustrated because they don't see the productivity spike they'd hoped for. What's really needed is process re-engineering by EHR vendors and clinicians alike. That means redesigning EHR tools so they're better suited for the clinical workflow process. It also means a willingness on the part of physicians to change the workflow process itself when EHR redesign and customization have reached their limits.

Jones and his colleagues make a similar point. Based on their analysis of IT systems in general, they say, "For every dollar invested in IT systems, firms typically had to invest several dollars for implementation, training, and process redesign to realize productivity gains." Equally important, the odds of seeing genuine productivity improvements required "incentive systems that reward team performance."

Frankly, you don't see a lot of team performance in healthcare. On the clinical side, there's a rigid physician-directed hierarchy, and that can hamper the process redesign process. Few healthcare stakeholders like to admit it, but all too often if the doctor who brings millions of dollars of business into the organization says, "No, I don't want to change," change rarely happens.

Sting may have it right. History will teach us nothing and the healthcare debacle will go on and on--that is, unless we have the will to redesign our tools, and our own mindset.

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