Health IT needs health leadership
When you’re a hammer, the old saw goes, every problem looks like a nail. So it goes with health information technology. Which, after $35 billion taxpayer dollars spent and untold billions of acetaminophen consumed by nurses and physicians,  remains a substantially federally-driven edifice to the perils of asking and answering the wrong question. Or at least yesterday’s question.
And those avoidable perils exist in health care, health advocacy, and any environment. The opportunity to address them is ours.
A forum co-hosted by the Bipartisan Policy Center and Health IT Now placed the issues in bold relief. The challenge begins that laws in the American federal system are built one upon another. The foundational health IT law was not about information technology at all: the Health Insurance Portability and Accountability Act of 1996 and its sworn-upon HIPAA regulations focused on protecting patient privacy and defined personal health information (PHI).
Yes, health IT laws chiefly date from 1996 when one could obtain 5,000 hours of free internet from a CD available at the grocery checkout counter.
Thus, of all the values information technology might offer patients, providers and investors, the one on which the U.S. health IT sector rests is to protect privacy. Privacy is hugely important. But so are the values of safety, quality, accuracy, convenience, affordability, timeliness and adherence to prescribed therapies. They are among the values that drove the subsequent Health Information Technology Economic and Clinical Health Act of 2009 (HITECH Act) spurring widespread health IT spending and adoption just as the social media revolution lifted off.
Dan Tucker, MD, the national coordinator of the U.S. Office of Health Information Technology, placed the culprit further back than 1996. In remarks to the forum, he fixed blame squarely on Medicare, enacted in 1965. The largest payer for health care in the United States is predicated upon fixing a price for every health care service as defined. Both its price-fixing and its documentation requirements drive technology based on record-keeping and not on solving problems in health. Nor on innovating.
Where might solutions lie? If neither the health care workforce nor patients are satisfied with the current system, why not start over notwithstanding the $35 billion sunk cost?
Easier said than done. Stephanie Zaremba of Athena Health noted that a system predicated on recordkeeping is not one naturally given to application development, timeliness or convenience, the values modeled by the most transformational modern applications. For example, Uber and Lyft disrupted mobility by frankly breaking local laws governing taxicabs. Consumer popularity forced municipalities to update. Is health care – also governed at national, state and local levels – like the cab or different?
But health care is more different from Uber and Lyft than similar. Catching an Uber or Lyft was a small-scale subversion for a time. But health care is just not run that way – and people wanting health and paying for it won’t stand for it. And people do not engage the health care system for the gee-whiz factor. They want health.
For organizations grappling with health IT as policy, and for those strategically planning its role in present and future service delivery, the BPC/Health IT Now forum nonetheless leaves a helpful breadcrumb trail:
1. Unlike industry which can replace one system with the other, laws and regulations at every level are cumulative, interdependent, and are eliminated and replaced only on purpose by political processes. That’s a big challenge. But it is known. So handle it in the same way one would eat an elephant one bite at a time.
2. Diversify and include from the start. Among the more intractable challenges in American health is that being black correlates with poorer health, shorter life expectancy, and three times greater likelihood of maternal mortality than for people who are white. The current system yields this unacceptable outcome. What better place to invest time and resources into transformational technology for health and care delivery than among people who can benefit? And who better to invite to participate in and lead these efforts than women and men from diverse ethnic and cultural backgrounds?
3. Bad policy and its victims result not from a lack of goodwill but from insufficient imagination followed by poor or isolated execution. Unlike technology industry, policymaking bodies are more trailing than leading indicators. But it suggests that leaders in organizations would do better to think and dream deep and make plans to achieve those long goals rather than tackle IT in cuts and bites.
4. Begin with the solution. One forum participant, HCA CIO Jim Jirjis, MD, oversees IT in an organization hosting 170 hospitals in 44 U.S. markets with differing systems and data architecture. Any one organization-wide query may take his team quite some data massaging time – weeks, maybe months. His dream for improving care and reducing risk: semantic interoperability organization-wide. Moore’s Law promises that much of today’s unobtanium becomes tomorrow’s application. And the rule of nature is that everything has a life cycle. So organizations and leaders should plan for them both.
HIMSS holds its 2018 conference in March in Las Vegas. Let’s see what further they hatch there.
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 For example in physicians, Shanafelt T et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clinic Proceedings 91:7,836-848, July 2016. http://www.mayoclinicproceedings.org/article/S0025-6196(16)30215-4/abstract, retrieved 2/27/2018.
 For example in nurses and other clinicians, Ommaya A, Cipriano P, et al. Care-centered clinical documentation in the digital environment: solutions to alleviate burnout. National Academy of Medicine discussion paper, perspectives: expert voices in health & health care, Jan. 29, 2018. https://nam.edu/wp-content/uploads/2018/01/Care-Centered-Clinical-Documentation.pdf, retrieved 2/28/2018. “This paper explores the relationship between clinical documentation, the electronic systems that support documentation, and clinician burnout, and provides recommendations for addressing these issues.”
 Marchibroda J et al. The future of government in health IT and digital health. Bipartisan Policy Center and Health IT Now, Washington, DC, Feb. 27, 2018. https://bipartisanpolicy.org/events/the-future-role-of-government-in-health-it-and-digital-health/, retrieved 2/27/2018, includes a report and its working group and the recorded webcast.
 P.L. 104-191. A summary of the HIPAA privacy rule and its amendments is available from the U.S. Department of Health and Human Services at https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html, retrieved 2/27/2018.
 P.L. 111-5, Division A Title XIII and Division B Title IV. The HITECH Act (notably, part of the American Recovery and Reinvestment Act of 2009, an $800 billion economic stimulus package) and several of its implementing regulations are posted by the U.S. Department of Health and Human Services at https://www.healthit.gov/policy-researchers-implementers/health-it-legislation, retrieved 2/28/2018.
 The most concise and well-referenced current summary I’ve seen on the state of health disparities in the U.S. may be found at National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); Jan. 11, 2017. 2, The State of Health Disparities in the United States. https://www.ncbi.nlm.nih.gov/books/NBK425844/. Retrieved 2/28/2018.
 Not a new idea or issue. See Ross V and Thomas V. Women and minorities in information technology. Computing Now, DoD HPCMP Users Conference 2008. https://www.computer.org/cms/ComputingNow/homepage/2010/0510/T_DoDConf_WomenandMinorities.pdf, retrieved 2/28/2018.
 A nice definition is provided at HIMSS. What is interoperability? http://www.himss.org/library/interoperability-standards/what-is-interoperability. Retrieved 2/28/2018.