In today's issue of Health Affairs, I wrote an article highlighting 5 guiding principles for spending stimulus funds wisely. You can download it online
Here's the abstract:
Making Smart Investments In Health Information Technology: Core Principles
Over the past five years, thousands of public- and private-sectoremployees, many volunteering their time, have worked to advancethe cause of interoperable, certified, secure electronic healthrecords. As new federal funds become available, should we investright away or wait for technology and policy perfection? Dowe leverage the accomplishments of existing national organizations,or do we start from scratch? The time to invest is now, buildingon the organizations we already have. To ensure wise investment,I suggest guiding principles assembled from the input of hundredsof providers, patients, payers, vendors, government employees,and standards-development organizations.
Your comments are welcome!
Tuesday, March 10, 2009
Making Smart Investments In HIT
Posted by John Halamka at 3:51 AM
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Would an open source format for an electronic record platform be the way to go?
John - To your point, through the years I spent implementing in the EMR world, we used the expression "Perfect is the Enemy of Good" frequently. I believe success of IT initiatives relies on proper expectation setting from the top down, including the notion that a "go-live" is merely the beginning of a process that will (hopefully) continue to evolve and allow for system optimizations and improvements in concurrence with policy.
"The vast majority of people don’t want technology for the sake of technology. Rather, they have something that they want to do or are already doing, and they only want technology if it can help them do those things better, faster, or more cheaply."
Great quote John.
Excellent article, thank you for posting the link. Rebecca, I agree 100% with your statement. Expectation setting is so important from the start.
The transformation to EHRs will only happen if it becomes no-brainer for two constituencies - providers and patients. The current breed of EHR solutions is not simple and intuitive enough to make it happen. It is up to the IT professionals to come up with a product easily adaptable by the providers and patients. Financial Incentives are fine. Open source looks good and may accelerate adoption rates but that is not the point. Let us focus on “pull” rather than “push” and build software solution that is too compelling to be ignored.
Dr. Halamka: We have worked very hard to build an implementation / technology service organization over the last several years in support of our community EHR deployment, so I'm right with you on this.
Where I live, we sometimes see a "region" defined as "West of the Mississippi", or "the West Coast", or "the Pacific Northwest". My hypothesis is that a "region" in the context you wrote about is much smaller than that, perhaps on the order of a community, and almost certainly smaller than most States.
What did you have in mind as you wrote this, and what, if any, recommendations would you make to policymakers in Washington DC in his regard?
Here's what I sent to federal folks who asked the same question:
"The coverage of such centers will vary based on local/regional requirements i.e.
Some may be multiple states (i.e. Wyoming/Montana/Idaho) and some may be metropolitan i.e. Eastern Massachusetts and Western Massachusetts.
There are a few existing examples of RHITEC's - the Massachusetts eHealth Collaborative and the New York City Department of Health
and Mental Hygiene Primary Care Information Project
I am confident that the Office of the National Coordinator will develop objective criteria for these centers and I hope these criteria are based on the MA/NY experience to date. In my view, the metropolitan scale is exactly the right level of granularity for most EHR rollouts. Only in areas with limited population density would I consider anything more regional/state."
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