This Time It's Personal

At the Healthcare Information and Management Systems Society (HIMSS) conference this week in Atlanta - 'transforming healthcare through IT' - an industry vertical snapshot of efforts to drive uptake and adoption of technology is taking place.

Efforts will be made sell IT solutions to hospitals and clinics so they can move from paper to digital records, with the society vision to 'advance the best use of information and management systems for the betterment of health care', the core goal.

Healthcare is a tightly regulated industry, with the Health Insurance Portability and Accountability Act (HIPAA) and the ANSI-accredited International Organization for Standardization (ISO) development organization Health Level Seven International (HL7) shadows looming large over North American proceedings.

However, as Dana Blankenhorn articulated last week

...The biggest problem the industry faces is that, while government may all be on one side, doctors and many patients are on the other side.

I personally see several doctors over the course of a year, and none have moved off paper. In my talks with them I find them terribly reluctant. They are waiting for someone — maybe the hospital where they have privileges — to both force them in and pay for it.

The reason for this is training. Doctors know how to use their paper forms. They know how to file them. They secure them by locking them in a room. In a small practice the cost of billing can be managed. Most Electronic Health Record (EHR) systems on the market require weeks of training, implementation and follow-up, and most internists’ offices are like busy freeways....

...Patients, meanwhile, appear ambivalent. While most, like me, are tired of the hassle involved in completing new paper forms whenever they see a new doctor, and often repeating the process with doctors they know, many also fear how the new electronic records might be shared with people they don’t know.<>

I describe this situation as an industry vertical snapshot because while not necessarily human life or death, countless other industries have the same core problem: getting people to use the expensive systems they install. This is true whether at modest or vast scale, particularly when there is a pre-existing precedent such as the paper based systems Dana described above, or a technology infrastructure people know their way around through training and years of usage patterns together.

Vendors sales pitches of sophisticated new technologies are seductive, and analysts paint  compelling pictures of the way industry verticals are likely to unfold, but the best laid plans can result in nothing but shelf ware that gathers dust if change management of usage patterns fail to take root.

While enterprise software projects tend to be binary - they are either launched to become the default single solution or they fail during development and pre launch - the less structured and elective use world of collaboration technologies is arguably much harder to debut and get people to show up and use.

Ironically, designing an environment to capture unstructured data and information typically requires clearly understanding the structure it is to fit into and serve. Before you can break rules you have to understand them, as jazz musicians know very well.

To continue a musical theme for a moment, the entry barriers to start using collaboration software are now extremely low for small groups, but all to often the informal effect is not unlike a few non musicians having a go on the brass section instruments. It's fun to have a go on the trombone but you're unlikely to be invited to do it again without actually learning a few songs to perform.

This gets to the core theme of this post: in the real world we behave in our own best interests, whether it's with regard to our medical records or deciding to blow our own horn on our own terms in our self regulated collaborative environment.

A couple of ramifications to this on larger collaborative levels: trivially, parents who claim to be 100% online literate and in favor of a school 'social' collaborative network to inform them about their kids insisting on one to one phone calls to organize a field trip. More seriously, managers tasked with developing and driving the adoption of large scale Enterprise 2.0 systems operating without senior management air cover or a safety net left exposed and vulnerable.

Lack of clear strategic intent, purpose and goals inevitably results in individuals continuing to interact and operate in their own best personal interests, to get things done in their most efficient way, and ignore any new solutions.

Fear of the unknown and lack of clarity around how people should behave results, as an example, in Doctors continuing to scribble notes on paper even as an expensive new structured system lies unpopulated.

Lack of clarity or intent around usage patterns can result in ad hoc uptake of enterprise collaboration systems that typically peak and then wane, having briefly been fashionable.

So often the transformative effects of IT are presumed to somehow imbue themselves in people's brains through usage, but that is simply not the case. Driving enduring usage requires clear understanding of structure, clearly communicated goals, demystification and training to succeed.

illegible doctor's notes from 'the cheerful oncologist'