Below is a guest post from Steven E. Waldren, MD MS.
I was listening to the Intel Health videocast of Eric Dishman, Dr. Bill Crounse, Dr. Andy Litt, and Dr. Graham Hughes. There was an introductory line that rang true, “EHR does not transform healthcare.” This statement prompted me to write this post.
The healthcare industry and policy makers have frequently seen health information technology (health IT) as a relatively easy fix to the quality and cost issues plaguing the U.S. health system. If we adopt health IT and make it interoperable, we will drastically improve quality and lower cost. Research provides evidence that health IT can do both.
I believe, however, that interpretation of this research misses a very important dependent variable; that variable is the sociotechnical system within which the health IT is deployed. For the uninitiated, Wikipedia provides a good description of a sociotechnical system. In essence, it is the system of people, workflow, information, and technology in a complex work environment. Healthcare is definitely a complex adaptive environment. To put a finer point on this, if you deploy health IT in an environment in which the people, workflow, and information are aligned to improve quality and lower cost, then you are likely to see those results. On the other hand, if you implement the technology in an environment in which the people, workflow, and information are not aligned, you will likely not see in either area.
Another reason it is important to look at health IT as a sociotechnical system is to couple the provider needs and capabilities to the health IT functions needed. I think, as an industry, we have not done this well. We too quickly jump into the technology, be it patient portal, registry, or e-prescribing, instead of focusing on the capability the IT is designed to enable, for example, patient collaboration, population management, or medication management, respectively.
Generally, the current crop of health IT has been focused on automating the business of healthcare, not on automating care delivery. The focus has been on generating and submitting billing, and generating documentation to justify billing. Supporting chronic disease management, prevention, or wellness promotion take a side seat if not a backseat. As the healthcare industry transitions to value-based payment, the focus has begun to change. As the healthcare system, we should focus on the capabilities that providers and hospitals need to support effective and efficient care delivery. From those capabilities, we can define the roles, workflows, data, and technology needed to support practices and hospitals in achieving those capabilities. Instead of adopting a standard, acquiring a piece of technology, or sending a message, by loosely coupling to the capabilities, we have a metric to determine whether we are successful.
If we do not focus on the people, workflow, data, and technology, but instead only focus on adopting health IT, we will struggle to achieve the “Triple Aim™,” to see any return on investment, or to improve the satisfaction of providers and patients. At this time, a real opportunity exists to further our understanding of the optimization of sociotechnical systems in healthcare and to create resources to deploy those learnings into the healthcare system. The opportunity requires us to expand our focus to the people, workflow, information, AND technology.
What questions do you have about healthcare IT?
Steven E. Waldren, MD MS, is the director, Alliance for eHealth Innovation at the American Academy of Family Physicians