The boldest thing I heard at my first day at HIMSS 13, the big healthcare IT event this week in New Orleans, was that the healthcare industry needs to be more like the airline industry. What could healthcare learn from a financially strapped industry that people love to hate?

It's the fact that U.S. commercial airlines carried 52% more people in 2010 than they did in 1995, and yet they employed 2% fewer people. It's that airlines did away with unprofitable luxuries such as meals in coach and filled excess flight capacity. It's that airlines shed lots of jobs at front counters and reservation call centers and replaced them with kiosks and online bookings.

"We do a bunch of their work for them -- and we like it," said Warner Thomas, CEO of Louisiana's big Ochsner Health System, during his HIMSS opening keynote. People today would howl in protest if they lost the ability to look online for their own flights and could do it only by phone, Thomas said. "How do we get people to make more of their own appointments for us, to check their own results?" he said.

[ In related news from HIMSS, some major EHR vendors are moving to break down walls between products. See EHR Vendors Form Alliance On Data Sharing. ]

Comparing the airline industry to the healthcare industry was an inspired choice by Thomas. It says not only that the healthcare industry must change, but also that those changes will be dramatic and gut wrenching. Thomas also pointed to banks' use of ATMs to let customers do self service, and to retailers such as Amazon.com and Wal-Mart using analytics to acquire a better understanding of their customers and their own operations.

Thomas laid out the big number: Healthcare must be 15% to 20% cheaper. That's not going to happen without pain and radical change. "It's going to take changes in how we do business," he said.

One example of this radical change I saw on the HIMSS show floor was the startup HealthSpot. It offers a telemedicine kiosk for remote patient-doctor interaction that includes not only video, but also a blood pressure cuff, thermometer, stethoscope and other tools a patient could use on himself with the supervision of a remote clinician. As I walked the HIMSS floor, though, I was struck by how few ideas like HealthSpot I saw that involved really radical changes to the way customers interact with their healthcare providers.

In his keynote Thomas laid out three results he expects healthcare IT to deliver: safer, higher-quality care; lower costs; and happier, more productive physicians and other caregivers.

I doubt that last one will always be possible. Getting to that future state of healthcare, one that costs as much as one-fifth less, won't always make people working in the industry -- or getting service from the industry -- happy. The airline industry has had to make some very hard choices about what services it can and can't provide. Healthcare has many more of those sometimes unpopular decisions ahead of it.

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