Early in 2011, I interviewed a CIO for a large health system in Canada, who had what I felt were keenly interesting observations on healthcare in the U.S. He'd been a CIO at multiple hospitals in the U.S., as a matter of fact, and had served in the military in a healthcare role, so his feedback is informed and relevant. Below are a few of the most intriguing comments:
- On U.S. Meaningful Use: It's interesting to me as I look at, talk to, and observe what's going on in the U.S., with respect to EMR and the quest for meaningful use dollars and so forth, how it has pushed organization after organization from a federated or decentralized or loosely integrated system - however you want to describe it - to a kind of model for managing IT. It's moved to a much more centralized, coordinated, and much better aligned system that's much better for the business model. Even in health systems that for the last 20 years have fought that tooth and nail. They wanted to maintain their local autonomy, etc., and with these meaningful use dollars on the table, followed maybe by a transfer to one of these accountable care organizations, most organizations that I'm familiar with are rethinking that, and becoming much more tightly aligned.
- On Project Management: Like anything else, there are maturity levels of project management, and I'll just make one up instead of trying to remember one, but there's obviously the model where there's no project management. You pick Sally for a project, and she goes off and does it. And then there's kind of an intermediate level, where an organization says, Oh yeah, we do project management, we have a project management office, and we report on our projects, but it's still highly variable, non-standardized, and really non evidence-based. And I think a lot of healthcare IT organizations are stuck at that level. Versus really rigorous project management, all based on data, with decisions made around the data, rather than assuming, it feels good to add one more person or delay a week or whatever it happens to be. So I think there are a lot of organizations that are stuck in that maturity curve, and the ones that are, are finding that they're stuck, because now, with the implementation of EMRs that obviously touch all points of the business, and that require business process changes, without the more mature PMO, you really don't have the ability to manage it well.
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On Business Intelligence: So if you look at even 5 years ago, the relative focus, complexity, management effort, and degree, again, of maturity of business intelligence, and it's all weighted over on the financial side. That's where the focus has been. So that's where we had the big complex revenue cycle systems, that's where we hired the consultants to optimize the revenue cycle, that's where we did business process improvement to improve throughput, doing a better job of collecting co-pays, etc.
And so now, all of a sudden, the focus has shifted - well, people say it's shifted - to clinical information, and what I'll call operational information in clinical operations. But the technology, the skills, and so on haven't kept pace with it, nor is there as much information available. Or at least not available in a consumable format. So, to just give you an example, here in Ontario, we collect pathology data in a standardized format from every laboratory in the province. Hundreds of thousands of pathology reports. And they're all in a synoptic, discrete data format, so they're not interpretive. And that took us a long time to drive that through all these laboratories and pathologists. But because we collect that, we now are able to grade, so to speak, or measure I guess is the more politically correct term, the efficacy, the quality, of certain kinds of procedures. For example, prostate resection.
We can now say that Doctor Jones has a much higher positive margin rate around prosectomies than his peers, and therefore somebody's got to talk to Doctor Jones because he's leaving cancer all over the place, which will result in bad outcomes for his patients. But to get to that level here, where we had some of those jurisdictional levers and data, that usually don't appear in the States, was a 5 year effort.
- On Why EMR's Will Follow the Financial Systems/ERP Maturity Cycle from IT: I've used this with boards in particular, and other business people when I was in consulting, and that is to draw the parallel between what is going on in healthcare today and what went on in financial services and other industries almost 20 years ago. You remember, I'm sure, all the bad press about ERP, and how Accenture was getting rich, and Deloitte, and all these other failed projects trying to implement Oracle, or SAP, or what have you. But if you look at financial services, they climbed the same maturity curve. In the 60's and 70's, they automated the back office (so they were building infrastructure), in the 80's and early 90's they automated the front office, ERP (so they were completing their instrumentation), then in the latter part of the 90's and early 2000's, they really got good at the informatics piece, and changing data into information, and then in the mid-2000's through 2008, before the world fell off the cliff, a lot of those businesses got very innovative based upon the information they had produced, from the instrumentation and infrastructure they had. I think the parallel is very striking.
What do you think?