Monday, January 19, 2009

The Big “O”

"O." No, not Oprah. Not Not even the big "O."

"O" as in Obama. A short jaunt around the web HIT postings, blogs, and news items these days quickly provides an overview of the impact of "O" on the current state of healthcare IT. For an industry that appeared to have become somewhat stalled with: abysmal reports on EHR adoption; standardization that seemed be slowing product innovation; and CHINs, RHIOs, and HIEs (with a few exceptions) failed or failing, the promises of the great and powerful "O" were like a shot of B12.

The incoming "O" has made lots of promises about advancing HIT, including megabucks and another of those "chicken in every pot" type remarks to provide an EHR for every American by 2014. (Believe that one?) Fifty billion dollar promises and a president who wants us all to electronify has been like the jolt of lightning awakening Dr. Frankenstein’s lifeless monster.

While it is encouraging that the new administration will have a much greater understanding and focus upon the importance of IT for healthcare, it seems O’s broad HIT promises have many abuzz that HIT is now poised to become an “overnight” success. (Like so many “overnight” success stories, it has admittedly been some quarter century we have been trying to achieve HIT stardom.)

Don’t get me wrong – I am all for the impact of the O-factor. The almost unbridled optimism that seems to have developed (even in some die-hard, conservative Republicans) for what the new administration may bring is quite contagious. The fact that O isn’t even in office yet and has already begun to steer the course of our country is quite impressive. The fact that so many initiatives seem to be under consideration is (and I don’t use the word cavalierly) awesome. Our country — cripes, the whole world — needs this optimism. We have some pretty major messes and we need some can-do folks at the helm.

What concerns me is the little “o”s, the folks who take what the big O says and immediately apply it to their personal agenda. Everyone sees the glory road to success as being whatever route leads past their own door. At the recent eHealth Initiative 5th Annual Conference in Washington, D.C., many vendors, politicos, and HIT proponents seemed quite enthralled that the 50 Big Ones promised by O over the next five years was the stimulus needed to finally push HIT past the tipping point. Of course, most of them also had a pretty specific idea about where that money needed to go to achieve the tip, usually somehow related to their current ambitions or agendas.

So, do I have my own agenda? Am I another little “o”? Of course. But, I’m trying to maintain a certain amount of historical perspective, too. The past 25 years have shown us that pushing HIT on both physicians and the general public is somewhat akin to pushing mules. You don’t get too far too fast. Merely telling a mule why they must move doesn’t work too well, either. Changing people’s expectations, processes, and workflow requires carrots, not whips, and turning those changes into habits is a derivative of time.

Hopefully, O and his people know this and just won’t throw those ever scarcer dollars to the little "o"s in hopes that what they’ve done before will somehow now work just because there’s money to burn. Yes, oh yes, we do need healthcare information integration and the technology it requires. But, what we really need are some disrupters to take advantage of this opportunity, to provide some innovative thought and leadership, and to figure how to turn “pushing mules” into riding race horses.

First posted on January, 19, 2009.

Next up: "Don't bitch and moan if you can't offer a solution"
or "Mine's better'n yours"

Thursday, January 1, 2009

There is No Epidural

The birth of a baby is an absolutely marvelous event; no matter how many thousands I’ve witnessed, I am always amazed at this most wondrous phenomenon. From their reactions, it seems this emotion is shared by most everyone.

This is why it strikes me as so bizarre that the birth pangs currently being endured by the labor of healthcare information technology (HIT) as we, en masse, struggle to give birth to this behemoth of a baby, are so universally abhorred.

A recent phone call from a prospective new adoptee of outpatient HIT asking my considerations on a particular electronic health record (EHR) prompted some reflection. He noted that a couple of previous references with whom he had spoken had lambasted their EHR for all the things that it could not do, for all the difficulties they had in switching over to their new workflows and processes, and for the EHR’s seeming lack of ability to just do what they had already been doing for so long with their trusty old pen-and-paper system. One complained about problems encountered with “printing his e-prescribing,” which I likened to buying a Maserati and driving it around in first gear. One even suggested he buy as simple a system as possible in order to simply document electronically (a glorified word processor program, in essence.)

Seems to me this is the same type of back-asswards thinking that has for so long thwarted the progress of so many innovations. People want something better than what they currently have, but are stymied by their inability to dissuade themselves from the “because that’s how we’ve always done it” mindset. People say they want new-and-improved, but only so long as it isn’t too different from what they already know. We tend to trust what we are and have and do, even if we are frustrated by the outcomes, even if we realize intellectually that there is probably a better way.

Seems to me, too, that most EHR vendors have not, and do not, make this situation any better. Most vendors with whom I have spoken, speak in the most glowing of terms about all the “fantastical” abilities which their systems will bestow upon a medical practice while completely glossing over the major changes the “body” of the practice will have to endure as it proceeds through the “gestation” and subsequent “birth” of this new “baby.” From Epic, NextGen, and Allscripts-Misys to MediNotes, Greenway, and SOAPware, every vendor promotes their contribution to this conception as if it were Jack’s magic bean, the seed from which a supernaturally wonderful new medical practice will grow.

Well, quite frankly...bullsquat. There is no magical electronic sperm which will combine with the egg of any established medical practice egg to produce an effortless gestation and painless perinatal period. And there is no epidural. There will be pain. There will be trauma. It will be difficult. Soooo...

...get over it. Changing workflows and processes is a painful transition. Living through the pain of development as these many superb EHR products mature is, well, painful. Birth can be a bitch, but, don’t forget: pen-and-paper sucks, too! The old, decrepit paper-based system will die (it is as I type) and this new baby will get born. Stop expecting the process to just slip in on top of what you are now doing. Stop expecting to benefit from new outcomes while continuing old ways.

We are oh, so very pregnant, the water has broken, and labor has begun. This baby is going to be born. Bite down, grab hold, and let's get on with bringing new life to healthcare.

And, don’t expect any epidural.