Friday, June 5, 2009

The Seven Myths of Healthcare Technology2. Technology Can Do Healthcare

"All involved in the healthcare industry will have to understand the entire healthcare system much more deeply than at present."
Dr. Steven F. Collier, CEO White River Rural Health, Arkansas, US

At the HIMSS GHIT conference this week, Doctor Steven F. Collier presented an overview of his work at White River Rural Health in Arkansas. As CEO, he has overseen the development and implementation of an EMR solution over the past 7 years. With a population spread across 10 counties living in towns (usually) of which the largest is less than 50,000, White River clinics are often the sole providers of healthcare to one of the poorest and most poorly served communities in the US. White River has been lauded as a model of best practices in implementation of EMRs to serve diverse, rural, under-resourced populations. The staff of White River has more than 6 years' experience in driving their technologists to develop and deliver solutions that would serve White River's understanding of their own business; so, when the doctor speaks of "understanding the entire healthcare system," he speaks from great experience and not a little pain.

As discussed in "Myth #1: Healthcare Does Technology," the very dialectics of healthcare are the opposite of those of technology. Healthcare is urgent, responsive and independent where technology development is planned, scalar, and collegial. Healthcare personnel neither understand nor welcome technologists in their environments--and the requirements of technologists do not track to the common expectations of healthcare organizations. Doctor Collier made clear that he is a healthcare provider. He spoke of results in clinical terms, of motivating problems as patient needs, and of success metrics in terms of patient wellness.

Technologists do not share this worldview. They speak of results in processing terms (operations/sec), of motivating problems as "needs for new calculus," and of success metrics in terms of technical performance. And while internal IT personnel may want to deliver solutions that serve the organizations' needs and timelines, external technologists are even less likely to succeed at healthcare. In addition to the cultural gap between technology and healthcare, they have the additional gap of being outsiders to the organization. And they are not just technologists--they are vendors.

Vendors have their own priorities, many of which are counter to both the organizational and the cultural interests of their healthcare clients. "Close-out" delivery of a completed solution is a goal of healthcare. Vendors in HIT have a number of self-serving goals that require more time and less closure. Often, technology solutions involve hastily or imperfectly written pieces of software which require more customization or "shake-down" time than a vendor might care to admit. As the HIT industry is growing so rapidly and as many of the vendor companies are so new, solutions are sold before they are fully developed. This leads vendors to use clients as "beta sites" to extend their development time while garnering revenue. Healthcare organizations are so eager for solutions and are often so averse to technology that they will buy "total solutions" with "full support and maintenance." This puts the IT infrastructure of an organization in the control of the vendor being paid to deliver it--where is the motivation for close-out in that? And vendors are businesses. They sell things; software, services, support, training. While interfacing with clients to deliver one product, they are motivated, even driven to upsell more products. which just pushes out the horizon to "solving the problem," when all healthcare wants is to solve the problem.

In a recent KLAS survey, of all organizations who reported a vendor promising tremendous ROI on an investment, not one was able to report actually realizing it within the original purchase. Not one.

So, if technologist can't do healthcare and if healthcare organizations can't do technology for themselves, what is the solution? Is there a third option?

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