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by Kent Bottles
Information technology will play a key role in whether hospital CEOs can transition from fee-for-service payment to global, value-based payment systems. It should be clear to everyone that the major 21st century challenge for American hospital CEOs is how to delivery high-quality healthcare for a lower per-capita cost.
Information technology also is critical to successfully caring for populations of patients in a wellness system, not the traditional disease system that has characterized American medicine.
Two quotations from hospital CEOs highlight the challenge for all hospital leaders:
"We're working on figuring out what roles we can play in keeping populations healthy, rather than just reacting to illness. But this requires a very different infrastructure than we've got today. The most critical piece of this is building the I.T. infrastructure to manage the sheer amount of data coming through our organization and using it to manage patient populations and outcomes. We don't have the data analytics to be successful in a new type of delivery." - Dan Wolterman, Memorial Hermann Healthcare System in Texas
"We're good at getting sick people better. But we're not a wellness organization right now. We fix people after they get hit by trucks. We don't try to get the trucks to go more slowly." - David Feinberg, UCLA Health System in California
I am worried that hospital CEOs are ignoring several IT pitfalls that are already out there ready to trip up well-meaning executives as they transition from a disease system to a wellness system of care.
Pitfall #1: Data breaches
The analysis of healthcare data breaches from 2009 to 2012 should make sleep difficult for any American hospital CEO. There have been 495 breaches reported that affected more than 500 individuals, and 57,000 breaches reported that affected fewer than 500 patients.
While hospitals and health plans are getting better at securing their data, physician offices are getting worse. And since physician offices are increasingly connected to the hospital computer system, the hospital CEO should be worried.
One expert estimates that the going rate for comprised hospital records is $1000 per patient. The hospital CEO who cares for thousands of patients must be concerned.
Pitfall #2: Tiny data versus big data
When I speak at accountable care organization conferences, there always is an IT consultant presenting on how "big data" will be essential for any ACO to succeed. I doubt most hospital CEOs really understand the concept of big data.
Steve Lohr provides the best quick definition of big data that I have read:
"Big Data is a shorthand label that typically means applying the tools of artificial intelligence, like machine learning, to vast new troves of data beyond that captured in standard databases. The new data sources include Web-browsing data trails, social network communications, sensor data, and surveillance data."
Before jumping into an expensive consulting contract with an IT wizard, the prudent hospital CEO should at least consider the advice of those who advocate utilizing "tiny data" to decrease per-capita healthcare cost. These contrarians advise hospital CEOs to concentrate on limited data sets that are readily available by identifying high-risk patients, establishing registries for common chronic diseases and partnering with payers for data and analytics.
Pitfall #3: Pesky patients want their damn data
Empowered patients are challenging everyone in the healthcare establishment for transparent access to their own health care data. Recent NPR and Wall Street Journal articles expand the traditional argument about hospital and physician medical records to the data from implantable medical devices.
A blog post by e-Patient Dave (a kidney cancer survivor and healthcare activist) commemorating the three-year anniversary of his Medicine 2.0 Keynote in Toronto entitled "Gimme My Damn Data" has a good summary of what empowered patients want in the way of data transparency.
Health IT will be critical to successfully transition from fee-for-service to global, value-based payment systems and change from a disease-centered healthcare system to a wellness healthcare system. Hospital CEOs must better understand the three pitfalls outlined above to avoid failure in this difficult time of transition.
Dr. Kent Bottles is a Senior Fellow at the Thomas Jefferson University School of Population Health.
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