Wednesday, December 28, 2011

A Look Back at 2011

2011 was a year of change and tumult.   For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.

It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.

What about the world of healthcare IT?

In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country.    Every aspect of the industry was stressed along the way
*Vendors were challenged to add the features necessary for certification resulting in some "haste makes waste" lack of usability and workflow integration.   GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
*IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets.   Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
*Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.

However, I would argue that we achieved David Blumenthal's goal of moving the "escalator" fast enough to create rapid change but not so fast that people fell off.   The one year delay in Stage 2 gives breathing room to all stakeholders to recover from Stage 1 and for laggards to catch up.

The Standards work needed for Stage 2 was completed and although there is still substantial work ahead, I believe that "good enough" content, vocabulary, and transport implementation guides are no longer the rate limiting step to healthcare information exchange.

The Policy work needed to support privacy, quality measurement, and patient engagement made significant strides.  As a country, we studied the PCAST report and incorporated its best ideas into existing federal efforts.

ONC itself matured in 2011, solidifying its operations under Farzad Mostashari, transforming from largely strategic to highly tactical, implementing the HITECH programs per the regulations written in 2010.  The Standards and Interoperability Framework filled the gap created when HITSP was sunseted.

In 2011, States were challenged to implement Regional Extension Centers, Healthcare Information Exchanges, and in some cases Beacon Communities, Challenge grants, and SHARP research programs. 

I believe there will be shining examples of success in some States, while others will provide lessons learned - political and technical - that will refine future work.

The REC program has been largely successful.   The HIE program is still an evolving work in progress, since HIE is technically and politically challenging, with limited alignment of incentives and few sustainability models.  

It's too early in the lifecycle of the research grants to assess their success.  Much hard work is being done to explore vocabularies, security, modular applications, and novel healthcare information exchange approaches.

In Massachusetts, all stakeholders - payers, providers, patients, employers, academia, and government aligned their efforts by forming an open, transparent state Advisory Committee (similar to a Federal Advisory Committee) to guide all state healthcare IT activities.  The energy and commitment from all the volunteers is inspiring.

2011 at BIDMC was a year of compliance - meeting new regulatory requirements of Meaningful Use, 5010, code 44 (short stay/observation verses inpatient), ICD-10, and the Fair Labor Standards Act (FLSA).    Major IT initiatives automated workflows to support these programs.

Infrastructure continued to grow with storage, bandwidth, and virtual machine enhancements to support Big Data.

Security challenges accelerated with more malware, more sophisticated hacking, and more regulatory penalties for data breaches.   In 2011, BIDMC had two publicly reported breaches, both of which were beyond our control, as they were caused by business associates on infrastructure we did not manage.   The emotional and monetary costs of breach reporting were very significant.

As I said in my post about the Joy of Success,  I believe that all my direct reports accomplished everything I asked them to do - we achieved meaningful use, addressed compliance requirements, and kept the IT staff stable/happy despite the stresses of the year.   They're heroes.

Harvard Medical School
In 2011, I continued to oversee the IT operations of Harvard Medical School during the CIO search process.   My goals have been to keep the IT staff happy, the infrastructure stable, and the budgets on track.   So far, so good.   My staff at Harvard also deserve a big thank you for a job well done.  My teaching, writing, and community service as a Harvard Professor continue at a brisk pace, but I've reduced my travel to the minimum possible to better balance my work and family life.

In December 2011 my wife was diagnosed with breast cancer, so my personal life has focused on family.   I'm supporting my wife by helping her prepare her artist studio and art gallery business for the 6-8 month hiatus ahead.   I've helped my daughter balance her college life, home life, and travel (she's in Japan now for a brief winter semester abroad) in the weeks following Kathy's cancer diagnosis.  I've put aside all my own pursuits including search for Vermont farmland.

On the positive side, the first semester at Tufts transformed my daughter into a self-reliant young woman.   My parents are healthy.  My own physical and mental health are good.   Our home and garden are well maintained and unlikely to cause a distraction over the next year.   Kathy and I continue to simplify our lives, reducing our belongings, and focusing on a lifestyle that is sustainable, low impact, and fulfilling.

In summary, 2011 was filled with high highs and low lows.   The pace was faster than any year in my life to date.  More happens every day in healthcare IT than the human brain can comprehend and I'm working harder than ever to filter the incoming data (and email) into knowledge and wisdom.

2012 will be a year of healthcare reform, new business intelligence/analytics tools, automating remaining paper processes, and creating the standards/policy/infrastructure necessary to accelerate health information exchange locally, regionally, and federally.     My only wish (beyond my wife's health) is that everyone will celebrate the problems we overcome rather than the focus on the challenges that persist.   Hard work is great if everyone around you is aligned for a successful journey rather than protecting themselves from blame when roadblocks appear along the way.

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