I am blogging to add my voice and perspective to the very important discussion of how to improve health around the world. I believe software and communications can make both incremental and transformational improvements to the delivery of health care — in developed and emerging countries. To be sure, software is just one factor — in many places, basic infrastructure improvements like clean water, proper waste disposal systems, basic supplies are way more important and high value than software, I get that. What I know is ‘great software’ and I can see how it, along with leadership in health organizations, can make a real difference.
The perspective I bring is that of a business person, entrepreneur and software guy — one that has seen software and the Internet transform the way we work, the way we communicate, the way brands are built and the economics of many industries — but not yet health delivery systems. There are lots of reasons why this is true — which I hope to address when building products and solutions for the marketplace.
The public debate about health policy and the role of government in the U.S. over the next 18 months is going to be significant in defining priorities and the nation’s options for the future. The questions are very complex — and we all have opinions about what is most important or most broken about our health system — but unfortunately the debate is generally not fully informed about the complex trade-offs involved in the dynamics of the health ecosystem. I certainly don’t claim to have all the answers, but I do hope to contribute to the debate.
One example came up this past week when the CBO published a report about the value of information technology in the health delivery system. The headlines that the report generated focused on the fact that technology "by itself" was unlikely to generate substantial savings — well like, duh! Technology "by itself" can’t accomplish anything. The ‘headline only’ discussion misses many key points both in the report and left out of the report — about the real, tangible benefits of the appropriate application of technology — in terms of improved safety/quality and lower costs. Many examples of good results are documented in the report even.
There are legitimate questions about how to generate the benefits (better quality, lower costs) of HIT, about who recognizes the benefits (buyer of HIT or payer/user of the health system) and about the overall costs/challenges to implement complex HIT systems in hospitals. If anyone thinks we can improve health costs or quality by using only paper based systems — I’d like to understand their argument. I don’t believe it and don’t suspect many others believe it. Consequently, the real question is not "whether HIT investments or not", but rather what investments generate the most value (what works) and what can be done to get more of what works. As I stated previously — it is the combination of leadership and software – that leads to benefits in better health outcomes and lower costs — see this article by John Glaser on this point.
The day this debate above about HIT value hit the headlines — I was participating the Future in Review conference, hosted by Mark Anderson. The contrast could not have been more striking — the participants were describing real and potential solutions to delivering value in health. William Haseltine described the great work he is doing in India — to dramatically lower the cost of certain surgical procedures — CABG and cataracts were examples. His examples of practice design, workflow specialization and component parts demonstrated huge cost savings and comparable or better quality results — which he hopes over time to export to the U.S. Roy Schoenberg of American Well talked about making real time, on demand communications with physicians a reality in the next several months. This will make a difference.
The exciting thing is that there is innovation everywhere — and motivated entrepreneurs and leaders that will figure out how to make stuff better.