In one of my recent discussions I had someone suggest the following idea:
You can’t model a solution to fix healthcare with the existing parts.
I found this to be a really intriguing idea that is worthy of some deep consideration by those of us involved in healthcare. I’ve often talked with people about the many perverse incentives that exist in our current healthcare system. There are so many incentives that point us the wrong way that the idea that we can’t model a solution to our healthcare cost problem makes a lot of sense to me.
Of course, I don’t think that this means we shouldn’t have hope that healthcare can’t be fixed. It just means that the fix will be much harder and that it will likely come from outside of the current healthcare system. You need to change the healthcare model to really dramatically improve our healthcare system.
I’m certainly bias, but I think that technology will serve as the basis for any new model. Unfortunately, most of the technology that’s been applied to healthcare is more about trying to make the current model more efficient as opposed to disrupting the current model. A great example of this is the EHR. As I posted previously, the EHR is not disruptive and never will be.
That’s not to say that the EHR doesn’t have value or benefits. There are a lot of benefits to EHR, but it won’t be the disruptive change that healthcare needs. I’ll be interested to see what mix of technologies, policies, and pressures lead to a really disruptive change in how we deliver healthcare.
While I’m optimistic that something will come that will really change the quality and efficiency of our healthcare, it’s not going to be an easy path.
Healthcare is indeed complex. “Fixing it” requires re-structuring that puts the focus on prevention, treatment, and long term outcomes data collection, in that order.
Right now the US healthcare system has it backwards.
There is nothing disruptive about EHRs. We had “charts” long before computers, now we have e-charts.
The first thing any healthcare professional needs to do at a patient encounter is to look at the chart to see what services have been rendered and what services have not been rendered.
As for most of the software that is on the market, manufacturers need to come to understand that clinic/hospital workflows are the result of years of trying to build a set of best practices to give the organization a competitive advantage.
Users are not happy when they are told “the system needs you to do it this way”.
Healthcare … easy fix, difficult stakeholders.
John —
Great question. I was having a conversation last week about how trying to solve a problem as posed does not always lead to a satisfactory conclusion. Often, we need to reach behind the question asked to understand the real question at issue. More often, we need to expand the tabletop, so to speak, where potential solutions are arrayed, so as to include solutions that address the meta-issue, not just the issue as initially articulated.
So, as you note, EHRs are not the solution to the “problem” of healthcare. The initial problem, of course, is definitional. What is the problem that we are trying to solve? Are we trying to address short-term costs? Been there, done that (e.g., capitation) and we created more problems than we solved. We push in on one side of the balloon, and the other side pushes out. Are we trying to improve quality? Well, what IS quality and how do we measure it?
I would argue that the problem to be solved is this: What needs to be done so that health care costs per capita in the U.S. go down to levels consistent with the rest of the developed world, while health care quality rises to levels consistent with the rest of the developed world? There are terms to define, to be sure, and since life (to say nothing of the Federal budget process) is a zero-sum game, the ancillary issue is how to pay for the solution to the problem without incurring net additional costs. (If we can look at this as a ten- or twenty-year problem, then it becomes easier to make this a zero-sum game.)
Better collection and use of information (including population health use of EHR data) has a role to play in solving this problem, but it doesn’t get us all the way there all by itself. We need to do a whole lot of other stuff: go 100% into a value based payment system, trim down the number of quality metrics we ask folks to look at, focus on process metrics only insofar as they are clearly causally related to outcome metrics, use the data at our disposal to design a personalized medicine approach to health care that will be more efficient and more cost-effective. There’s plenty more to add to this list …..
Thanks for starting this conversation.
What is the reason to disrupt and innovate if competition is truly not a concern?
The challenge with solving problems within existing structures is convincing those who profit from the current structure to change. In a consumer-driven health care economy, user demands would drive innovation and disruption. In a payor-driven health care system like ours, the impetus for change is cost. The trouble is that disruption and innovation are slow to take hold because cost transparency does not exist and users are relatively insulated from the costs of healthcare, until extensive health care services are needed.
The other challenges lies in how health care systems are responding to disruption and innovation – with greater vertical integration. What is happening is not a greater willingness for cross-system communication and integration but bigger fiefdoms and higher walls that prevent the mobility across systems.
The truth is, health care systems do not compete against each other to retain members (users) or providers (doctors, services), they compete for employer private networks. Therein lies your problem. I’m biased but I think best way to counter all of this is to driver greater consumer transparency and choice.
Change the factors of competition from employers to users and you will the pace and adoption of innovation change drastically.