Down To Business: Electronic Healthcare Won't Be Denied
Obstacles abound, no doubt. But three huge constituents will demand it: government, large providers -- and the customers who will benefit.
What we're witnessing is "the single fastest transformation of an industry in the history of the United States." The commentator: Glen Tullman, CEO of Allscripts. The industry: healthcare, where system vendors like Tullman's are at the center of driving that digital transformation.
Is this just hyperbole from an industry player? Consider that the federal government is spending upwards of $20 billion to get healthcare providers to digitize their records and processes, and that 70% of that money must be spent over the next three years. For an industry still mired in 20th century practices, an electronic overhaul in just a few years would indeed be historic.
As with any industry, there's already a 10% group of IT early adopters in healthcare -- the likes of Kaiser-Permanente and Intermountain Healthcare and University of Pittsburgh Medical Center. It's that fat 70% of providers in the middle -- the so-called fast followers -- that will follow much faster than they normally would now that the government is brandishing the "meaningful use" carrot and stick.
In comparison, it took the auto industry more than a decade to automate its complex supply chain. Retailers took about as long to follow Wal-Mart's lead. Airlines moved from paper ticketing to electronic kiosks in a couple of years, but that migration was relatively limited in scope. In healthcare, we're talking about one-sixth of the U.S. economy -- providers, payers, insurers, and myriad other third parties -- scrambling to collect, store, distribute, share, and act on information in wholly new ways over the course of just a few years. The people, process, and financial challenges are beyond daunting.
In his opening remarks at last week's gigantic Healthcare Information and Management Systems Society conference in Atlanta, where the smell of meaningful use money was in the air, HIMSS chairman Dr. Barry Chaiken said there's precedent for information technology quickly changing how many millions of people work: e-mail and the now ubiquitous in-box. Workers didn't need to be forced to use e-mail (and the Internet), he noted; they demanded to use them "because they made their jobs easier and made them more productive." Likewise, he called on the healthcare IT industry to create solutions "that are so compelling, so irresistible, that people just want to use them. We cannot rely on incentive programs or executive orders."
"We must create electronic systems so appealing that they make physicians want to leave their paper medical records behind," Dr. Chaiken said. "We must create clinical decision support systems that make it routine for physicians to check their internal knowledge with data and evidence. We must offer workflow solutions that improve the efficiency of using health IT. We must make physicians want, yes, demand, the enormous power that IT brings to the practice of medicine." He envisions a "higher level of medical practice, one where both physicians and nurses can concentrate on examining, interacting, and motivating patients while technology handles the burdens of collecting, storing, and accessing data."
No doubt the healthcare IT industry must rise to Dr. Chaiken's challenge. But so must healthcare providers themselves. Their resistance to technology is less about the intuitiveness of the hardware and software and more about their habits, the attitude that the way they've always done things serves patients just fine while paying the bills.
The IT challenge before the healthcare industry is less like the mainstream adoption of e-mail and the Internet and more like what companies went through in the 1990s to automate their financial, manufacturing, HR, supply chain management, and sales processes by way of ERP, CRM, and related enterprise applications. That migration was massively complex and expensive -- not only the software and training, but also the business lost as people adapted to new systems and processes. ERP, CRM, and SCM disasters were legion, especially among organizations whose people were dragged into the changes kicking and screaming.
Not to be underestimated as the healthcare industry is dragged into the digital age is the fact that doctors and nurses, especially those in small practices, get compensated based on the number of patients they see in a given day. Just as salespeople resisted CRM a decade ago (and even today), doctors, nurses, and administrators will continue to shun any IT tool that gets in the way of their seeing as many patients as they now do, even if it's only short term. Meantime, patients' health, not just healthcare providers' livelihoods, lay in the balance of this transition.
Government financial incentives and penalties will do only so much. Some compare the meaningful use guidelines to "cash for clunkers," generating a frenzy of short-lived activity. But what happens when the money runs out? Will healthcare providers still be as committed to digitization?
My estimation is yes -- the business and patient care case will demand that they commit fully to digitally based records and processes. Just as Wal-Mart forced its far-flung supply chain to adhere to its electronic standards, the big HMOs, government payer organizations, and insurance companies will pull the vast healthcare ecosystem into the digital era.
Ultimately, however, healthcare IT won't reach its full potential until patients decide they won't do business with providers that don't make use of the latest clinical care, customer service, and other IT systems and tools. Some of us may complain that our doctor practices like Marcus Welby, but are we ready to choose another provider for that reason? When doctors' offices and hospitals start advertising their IT capabilities, we'll know we're really making progress. We're very close to that day.