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?

The Seven Myths of Healthcare Technology: 1. Healthcare Can Do Technology

80% of healthcare organizations want vendor-neutral advice on technology purchasing decisions, according to the newest survey by the eHealth Initiative www.ehealthinitiative.org, and 92% want guidance for workflow modification related to technology implementation. More than 320 organizations of the 425 surveyed say that they cannot do it for themselves and overwhelmingly want funds from the health IT provisions of the American Recovery and Reinvestment Act directed to these issues. (the entire survey is available from their website hereHow is this? Hospitals and healthcare organizations are big, complicated systems managing services as varied as nutrition and transportation. At first glance, it would seem logical that information technology would be just one more service area in the portfolio. But then, healthcare teaches us that first glances are usually wrong.

Healthcare is urgent. It is about reacting to a problem and driving as quickly as possible to the diagnosis. Escalation is to specialists of ever-more granular views. Healthcare priorities are patient care, diagnosis and treatment--speed in all things.

Technology development and implementation is none of these things. IT requires long-term, broad-vision strategy and planning. To be successful, it must be both proactive and patient--and while technologists are known to carry every detail in their heads, specialization is antithetical to valuable solutions. Where healthcare providers are trained to "make the call," technologists are collegial. Technologists seek the input of others and work in "teams."

Healthcare organizations are driven to seek technology solutions. The needs to reduce costs, to improve patient safety and to increase patient service rates have been joined by Federal mandates in both the US and Canada. Two approaches have been used to get manage technology in healthcare environments. Neither of these is truly successful, as both are bound for failure from the start.

Many organizations try integration of a technology group. This is never easy and rarely a complete success--by any metric. In the revenue-centric organizations of the US, internal IT resources are viewed as cost centers without billable services and ever-expanding maintenance expenses. Technical personnel are only welcome on the floor if they are there for an immediate problem--to fix or replace something. Even in the non-revenue driven facilities (in Canada, for example), the balance of investment is tilts in favor of direct patient-care costs over long-term technology investment. In all organizations, the longer, planned cycles of research and development are not seen as contributing to patient care, and the time required for interaction with providers is largely seen as a distraction from patient care. The cultural difference between providers--reactive and urgent--and technologists--proactive and considered--is a source of conflict and an extra impediment to successful development and deployment of new technologies.

Other organizations trust management of new technology endeavors to the outside vendors from whom they purchase their technology. However, this approach almost invariably costs a great deal more than expected and there is little control of ongoing maintenance costs. As documented in today's KLAS study,

Building the case for and helping a client achieve an ROI is something that every vendor reports they do well, yet not a single provider said that their vendor had truly met their expectations. Providers continually expressed their willingness to have a vendor come in and optimize their systems and processes to help get more out of their investment, but few vendors are willing to deliver on that invitation without significant cash from the provider...No major IT vendor in healthcare is leading out with creative, helpful solutions to reduce ongoing financial concerns. Chief among these concerns are the routine maintenance fees inherent to major IT service contracts.

Executive Reaction to the Stimulus Package, May 2009
KLAS Confidential Information.
© 2009 KLAS Enterprises, LLC. All rights reserved.

Most hospitals try to use some combination of these two approaches. This results in multiple layers of management; internal vendor managing IT staff, internal support management, external vendor management, external client-relations management and clinical management. And this model doesn't serve the priorities of the facility successfully.

So, how to succeed? How to develop valuable technology solutions that a healthcare organization can use, manage, maintain and integrate into the healthcare culture? Perhaps the more than 300 organizations that responded to the eHealth Initiative survey have it right and do not even realize it--an external resource to support dissemination of best practices, to provide technical assistance, to aid with workflow modification and most importantly, vendor-neutral advice.

For more on this, see tomorrow's The Seven Myths of Healthcare Technology: 2. Technology Can Do Healthcare

As always, let us know your thoughts and experiences. We will bring them into the discussion.