January / February 2008
Health IT and Quality
Healthcare IT:
Slogan or Solution?
By Barry P. Chaiken, MD, FHIMSS
In 1980, Stanford University School of Business professor Alain Enthoven wrote a book titled Health Plan: The Only Practical Solution to the Soaring Cost of Medical Care. Dr. Enthoven provided the theoretical underpinnings of managed competition, an approach to reducing healthcare costs embraced by the Clinton administration's Task Force on National Health Care Reform. Chaired by then first lady Hillary Rodham Clinton, the task force failed to convince Congress to pass comprehensive healthcare reform legislation. This unsuccessful "breakthrough solution" was just one of many proposed over the last 30 years to save our healthcare system from collapse.
In 1980, Stanford University School of Business professor Alain Enthoven wrote a book titled Health Plan: The Only Practical Solution to the Soaring Cost of Medical Care. Dr. Enthoven provided the theoretical underpinnings of managed competition, an approach to reducing healthcare costs embraced by the Clinton administration's Task Force on National Health Care Reform. Chaired by then first lady Hillary Rodham Clinton, the task force failed to convince Congress to pass comprehensive healthcare reform legislation. This unsuccessful "breakthrough solution" was just one of many proposed over the last 30 years to save our healthcare system from collapse.
In the 1980s, managed care and managed competition became the flavors of the month. In the 1990s, appropriateness pre-certification, disease management and provider profiling came in vogue. In this new millennium, healthcare information technology is being touted to save us from this long-standing crisis.
On the first page of his book Enthoven wrote about the strain that healthcare costs were putting on federal, state and local governments. He then addressed the private sector, particularly the automobile industry, where soaring health insurance costs were a difficult burden on employers. According to Enthoven, healthcare costs made up 6.2% of GDP in 1965 and ballooned to 9.1% in 1978. Today, healthcare costs eat up more than 16% of GDP. In the 27 years since Enthoven published his book, the United States has seen little progress in controlling healthcare expenditures.
Although our healthcare system struggles with access, covering the uninsured, and medical errors, Americans generally receive pretty good healthcare, especially when their illness is not routine. Unfortunately, the resources currently required to provide that level of care are beginning to impact our standard of living and competitiveness in the world.
Unequivocally, healthcare information technology alone cannot solve the problems our nation faces in delivering high quality, affordable healthcare to all Americans.
HIT Is Just a Tool
Like a scalpel in a trained surgeon's hand, healthcare information technology is a tool; if intelligently applied, it offers the skilled professional refined capabilities that can deliver miraculous outcomes. For all of us who work in healthcare IT, the challenge to is to figure out for our organizations how to deploy an HIT tool so that it fits perfectly the hand and intellect of each and every caregiver. Providing a blunt instrument that unintelligently supports the status quo does nothing to improve results.
So, what are our next steps? If we continue to approach the problem the same way, looking for some silver bullet, we can only expect the same outcome. Therefore, it is time for us to try something new.
A comprehensive approach to healthcare reform is necessary. Everyone, including physicians, nurses, patients, administrators, and insurers must work together to form the solution. Continuing to approach illness and deliver care the same way we have been doing for decades is sure folly.
Change, Change, Change
Physicians and nurses must begin to see their responsibilities in a different light and begin to do their tasks differently. Administrators and insurers must assist and incent them. Patients must take responsibility for their care and work to prevent illness rather than wait passively for resource-intense medical miracles to fix them.
Physicians must direct care and prescribe therapies according to science and rational thinking rather than habit and personal preference.
Healthcare information technology can provide some critical tools to achieve this necessary change, but those working within the healthcare system must employ these tools in different workflows and processes. Utilizing the tools to "automate" existing processes only works to continue delivering unacceptable outcomes.
If we want to truly address our problem of spiraling healthcare costs, it is time to get to work fostering the change management necessary to reform our healthcare system for the better. Otherwise, we will read Enthoven's book a decade hence and realize nothing has changed except for the slogan.
Barry Chaiken has more than 20 years of experience in medical research, epidemiology, clinical information technology, and patient safety. As founder of his own company, he has worked on quality improvement studies and clinical investigations for the National Institutes of Health, Framingham Heart Study, and Boston University Medical School. Chaiken is board certified in general preventive medicine and public health and is a Fellow and Board Member of HIMSS. He is the chief medical officer of DocsNetwork, Ltd., adjunct assistant professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine, and serves on the Editorial Advisory Board for Patient Safety and Quality Healthcare. He may be contacted at bchaiken@docsnetwork.com.
References
Enthoven A. (1980). Health plan: The only practical solution to the soaring cost of medical care. Reading, MA: Addison-Wesley Publishing Company.
Chaiken B. P. (2005). Path innovation: Transcending automation. Patient Safety and Quality Healthcare, 2(3):46-47.
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