Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Where does health care IT hurt? Everywhere.

John Halamka, MD
Tech
December 1, 2016
505 Shares
Share
Tweet
Share

Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada.

Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress.

I’m often asked by senior government officials to help harmonize IT strategy at the country level. That — I can do.

I frequently say that health care IT issues are the same all over the world. Here are a few common observations:

1. Top down never works. In every country I’ve visited (there are 195 in the world right now, and I’ve been to about half), I’ve never found a health care IT program that succeeds by disenfranchising stakeholders and imposing a solution from above. Asking users what they want/need, then working collaboratively to deliver a workflow solution that enables them to practice at the top of their license tends to overcome any resistance to technology implementations.

2. A single EHR for a state, province or country never works. The VA, Kaiser, and Department of Defense are completely vertically integrated which means that payers and providers in all sites of care (inpatient, outpatient, emergency, urgent care, long-term care) are part of the same organization and management structure. A single EHR platform works in those circumstances. However, when a country has private payers, private providers or a mixture of a public payer with private providers, there is not a single command and control structure. There will be heterogeneity in requirements and care processes. A single EHR vendor cannot support all use cases. Similarly, having 50 different EHRs is unlikely to provide the data integration and care coordination needed by a regional group of health care organizations. The right answer is a parsimonious approach — the fewest number of EHRs and technology tools to meet the needs of the region — not one and not 50. In Eastern Massachusetts, we use about six.

3. Interoperability needs a business case, a workflow and good policies. I was recently asked to define interoperability. I suggested that interoperability is having access to the data you need to coordinate care when you need it without a lot of effort or cost. If clinicians are paid more for repeating tests, they will repeat tests. If sharing records requires a convoluted workflow using some application outside of the EHR, clinicians will rarely take the time to exchange data. If privacy policies do not clearly define consent and allowable uses of data, clinicians will be too intimidated by compliance issues to embrace health care information exchange. Make data sharing part of the job/pay program, make it integrated into the EHR and standardize the process for making data available to all stakeholders who need it, then data will flow.

4. There may not be a measurable return on a health care IT investment. One international hospital I recently visited said their hospital information system was a failure because they did not see a return on investment one month after implementation. Another I visited said they would reduce costs by shifting all the work to the clinicians, saving on administrative costs. Both are completely unrealistic expectations. In my 20 years of traveling the world, I’ve seen health care IT projects that improve quality in measurable ways — reducing readmissions, enhancing medication compliance and improving processes. I’ve seen safety enhancements that markedly reduce errors. I’ve seen automation, such as complex order sets, improve efficiency. However, I’ve never experienced an IT project that reduces costs when all expenses of implementation and operation are accounted for.

5. The experience of past patients can inform the care of future patients. Different countries have different terms for this idea — big data, precision medicine, a learning health care system, population health and care management. If a society pools clinical data, financial data, social determinants of health data, government services data (food stamps, criminal justice, family services) and patient-generated data, it is possible to ask questions about care already delivered to refine care yet to be delivered. Many societies are thinking about the benefits of population-level data aggregations that may be anonymized to protect the privacy of individual patients.

John Halamka is chief information officer, Beth Israel Deaconess Medical Center, Boston, MA, and blogs at Life as a Healthcare CIO.

Image credit: Shutterstock.com

Prev

Reminder: Keep it simple for outpatients

December 1, 2016 Kevin 3
…
Next

Sleep deprived and exhausted? These tips will help.

December 1, 2016 Kevin 0
…

Tagged as: Health IT

Post navigation

< Previous Post
Reminder: Keep it simple for outpatients
Next Post >
Sleep deprived and exhausted? These tips will help.

More by John Halamka, MD

  • The future of EHR: Here are 5 predictions

    John Halamka, MD
  • 10 crucial guidelines for health care IT

    John Halamka, MD
  • 5 health care IT tips for President Trump

    John Halamka, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • America leads the world in high tech care and health care costs

    Mark Kelley, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA

More in Tech

  • The pros and cons of using ChatGPT for your health care needs

    Liudmila Schafer, MD
  • A new era of collaboration between AI and health care professionals

    Harvey Castro, MD, MBA
  • What I think it means to be a medical student in the wake of AI

    Jackson J. McCue
  • The rise of generative AI in health care: Here’s what you need to know

    Anil Saldanha
  • Can AI solve the physician shortage crisis?

    Harry Severance, MD
  • Bridging the digital divide: How to bring trust back into the patient-physician relationship

    Arti Masturzo, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician
    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public
  • Is It Business as Usual for the Drug Industry?

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician
    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Where does health care IT hurt? Everywhere.
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...