Today I spoke at a very well attended Health Affairs event in Washington DC -- originally designed (months ago in a different time warp in HIT light years) to discuss lessons learned by folks leveraging HIT in effective ways, along with the usual challenges, issues and opportunities. Naturally the discussion was hijacked by the implications, potential consequences and opportunities raised by the ARRA stimulus act and the HITech portion of it in particular.
There is much to report from the event -- because there were a lot of smart and thoughtful panelists -- and because the issues are at the same time complicated, familiar and not super well understood. I don't have time to cover them all in this post.
There is a strong consensus (it showed up in comments from many panelists) around the theme I care most about -- which is we must focus on the outcomes one wants to achieve (better health outcomes at the same or lower cost) and then encourage innovation between providers and technology suppliers to deliver those outcomes. Said another way -- technology is a tool (a means) and not an end in itself. This is why health reform and the health stimulus have to be intertwined and self-reinforcing. Just spending money on HIT is not going to lead to the 'down payment' (i.e. future savings) that Obama believes it is.
Mark Smith brought this to life most effectively in his remarks -- that by adding a computer to Kramer's bookstore you don't end up turning it into Amazon.com. Kaiser reported in the article summarizing the experience in Hawaii with KP Healthconnect (EMR) -- that family practice office visits went down by 25+%. For Kaiser, an integrated delivery network and health plan -- that is a benefit to their bottom line. (I should note patient satisfaction went up in this period because needs were met by phone/email -- a totally win/win situation for Kaiser and consumer alike). For a more typical, small office family physician -- that is a disaster...because revenues are tied to visits. To succeed, we have to change the paradigm of healthcare away from the tyranny of the visit based payment system (Kramer's bookstore) and reward longitudinal care systems (future amazon.com). If we spend a bunch of money automating existing systems of care -- and not enabling new platforms -- we have missed the huge opportunity to make a difference.
Carol Diamond made the subtle, but I think hugely important point that has not fully sunk in to the folks waiting at the starting line of the HIT land rush -- that the public is going to expect accountability for improved outcomes with the stimulus spend. Health touches everyone -- and if the country spends $30+Billion dollars on 'investment' and the average citizen experience with the health delivery network is no different and costs continue to rise -- there is going to be accountability for where did the money go. She is rightly trying to focus the minds of the folks with the wagons -- better pick your spots wisely -- just getting a homestead isn't good enough -- it had better be productive land.
My biggest ah-ha moment came a few hours after the event in a conversation with the CEO of a large player in the healthcare supply chain. I realized that a significant portion of the Health Affairs event, the broader conversation about overall HIT investments and the specific conversation I was having ALL ACKNOWLEDGED and CONCLUDED that individuals (people, patients, consumers, whatever label we want to use) have a right to a personally controlled health record and that the personally controlled health data management platform is a critical component (perhaps a necessary component) of ANY FUTURE HEALTH IT SYSTEM and probably any payment reform system.
The ah-ha point is -- Microsoft has made a difference -- a huge difference -- by taking the leadership role it did 3 years ago by investing in building, defining, evangelizing, shipping and refining a personally controlled health data management system, HealthVault. We have a long way to go to make it easy, ubiquitous and fully connected -- and to deliver the value I know it will to consumers/patients in their everyday health lives. But I know it is a good and innovative idea and one that has changed and framed the debate in a positive way. While I have always believed that -- to see the effect and reality of the impact -- made my day.