The Blumenthal bet in health IT
Summary: A variety of approaches will be selected, a variety of vendor groups and technologies, but the aim of the "beacon community" plan is to see whether one community, somewhere, can deliver the promise of health IT -- lower costs and high-quality care.
Acceleration through example.
This is the strategy National Coordinator for Health IT David Blumenthal has chosen to pursue, and on it may rest the fate of the whole Obama Administration.
Rather than trying to reform the whole industry, Blumenthal's aim is to create at least one example of doing things right, then bring the lessons of those best practices to other communities.
This effort will start next month through the selection of "beacon communities," but my guess is those cities and towns will really be semi-finalists.
A variety of approaches will be selected, a variety of vendor groups and technologies, but the aim of the "beacon community" plan is to see whether one community, somewhere, can deliver the promise of health IT -- lower costs and high-quality care.
The "how" in this case will be as important as the result, because the next step will be to boil the community's results down into lessons, principles, a curricula if you will, that can be expanded outward to the rest of the country.
In this way he hopes to avoid Moore's Law of Training -- there is no Moore's Law of Training -- and the fears of Gartner analyst Wes Rishel, who delivered a "rant on health information technology asynchrony" over the weekend.
The natural slow adoption of technology and the need for interoperability were Rishel's themes, and when you look at the entire field his concerns are valid.
Small organizations are reluctant to change, and large ones change slowly because many people must be trained to use new tools. This is what I call Moore's Law of Training -- people learn only as fast as they learn.
But if you focus on just a few places, forcing the process with the hope of money and fame, you create industry leaders, best practices, and a road map others can follow.
Businesses fight to create just such practices within their organizations, but then wrap up this "secret sauce" as trade secrets to maintain their hard-won advantage.
Blumenthal is betting that federal money from the stimulus can open up these silos.
I think we should discuss this approach, not just in terms of health IT, but in terms of systemic change generally. If someone shows you they know what they are doing, and then hand you a set of instructions based on their knowledge, will your organization change faster?
I know it doesn't work in real estate. New cities like Peachtree City in Georgia, even when successful, were not copied by the market. Neither were innovative communities like Seaside in Florida or the Rouse marketplaces.
I know it did work in education, long ago. America's great public education system emerged from examples set by Horace Mann and the New York schools. The fastest way to make yourself some money in real estate may be to make your local public school a magnet.
So will it work in health care? Can it? Or is Moore's Law of Training (there is no Moore's Law of Training) absolute?
Kick off your day with ZDNet's daily email newsletter. It's the freshest tech news and opinion, served hot. Get it.
Talkback
Innovation & Commonality
commonality between systems. If a system cannot be successfully
integrated with other systems then it should be a failure.
Hopefully the VA IT will get significant funding as it is a solid performer
for practitioners and patients alike,
Make or buy in government accounts
How money is spent is as important as how much.
RE: The Blumenthal bet in health IT
Probably not, since what will be likely be lacking is what Greenhalgh et al. at University College London describe as studies of the EPR in organizations that "tell it like it is", in the article "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method." Link: http://eprints.ucl.ac.uk/18821/
They write:
... as a cross-cutting theme in all the above areas, the realpolitik of EPR projects within and between organizations and interest groups should be more explicitly explored ... Orlikowski and Yates have called for more research on the 'messy, dynamic, contested, contingent, negotiated, improvised, heterogeneous, and multi-level character of ICTs in organizations' (page 132) (Orlikowski and Yates 2006). We suggest that sponsors and publishers eschew sanitized accounts of successful projects and instead invite studies of the EPR in organizations that 'tell it like it is' perhaps using the critical fiction technique to ensure anonymity (Winter 1986).
As long as accounts of health IT problems are sanitized and massaged by the timid, the politically correct and/or the professionally or financially conflicted, the appropriate "instructions" (i.e., not just on "best practices" a.k.a. "what to do", but on "what NOT to do", with specific examples) will not appear.