Saturday, February 01, 2014

Clinging stubbornly to an outdated IT enterprise model

Sometime back, I compared the relationship between health systems and Epic, one of the biggest health care IT companies, to the Stockholm Syndrome.  To review:

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

This did not endear me to people in certain quarters, as you can imagine.  But the issue still exists, and more broadly than just for this company. Here's a description by Jonathan Bush, CEO of athenahealth.*

In health care most information technology (IT) companies continue to cling stubbornly to an outdated enterprise model. They charge enormous capital outlays for software acquisition and then levy exorbitant fees for ongoing service contracts. As long as the sale closes, they prosper. If their clients struggle with adoption or fall short on outcomes…they still prosper. Not only is there no incentive for information to flow freely across these systems but the companies selling them are profiting by helping to lock vital information within proprietary data silos.

Health care IT companies that fail to support the free flow of information may see a short-term business advantage, but any business model so divorced from social utility is destined for long-term failure. Much better to innovate, reinvent and evolve.

The fierce competitors in the financial services industry long ago concluded that they would all be much better off if information flowed. It is time for health care IT vendors to follow suit: compete on dimensions of service that benefit patients; create workflows that allow physicians to function at the top of their abilities; bring actionable information to caregivers at critical decision points; and support innovative care models. 

He concludes optimistically:

It will take some time but barriers to medical data interoperability will crumble—with profound benefits to society: Patient harm and inconvenience resulting from botched communications will become rare. More research will be conducted in real-world conditions, answering questions currently beyond reach. Consumers will be able to choose providers best positioned to address their concerns without struggling with the hassles of transferring information. And as medical information becomes seamlessly integrated with physician workflow, physicians can focus on what attracted them to medicine in the first place: caring for their patients.

I am not so optimistic, as I see the market concentration that the government is encouraging in health care systems as working against market forces that would promote such interoperability.

* Disclosure: I write occasional articles for athenaheath's website.


Jeff Carlisle said...

If possible, I might even take a slightly more cynical view of EMR's.

Anonymous said...

Bush's commentary is absolutely on point. But those who rail against EMR's in medicine, are, quite frankly, dead wrong and tragically short-sighted. They are a no-brainer. It's the execution which has gone wrong and parallels the changes in health care more broadly - the powerful legacy interests maintain the status quo for as long as they can, using all their power and accumulated dollars to do so.
As far as the government's blundering, I give them high marks for pushing the issue. Once again Paul, you criticize the execution while I say, what would you have them do? Do nothing and continue with the single digit adoption rate that prevailed before? The ball must start rolling somewhere.


Paul Levy said...

It's not a choice between doing nothing and doing it as they do it:

The government could have included requirements for true interoperability along with the billions of dollars they appropriated for EMRs.

Anonymous said...

As you know there are interop requirements but they are probably inadequate and constrained by the fact that legacy systems in hospitals simply don't work that way. But again, better than nothing, which is what we had before.

It's a matter of expectations; mine have always been fairly low. (:


Anonymous said...

I hope very much that information will flow. But I remain cynical. The "fierce competitors" in Finance concluded that data flow was profitable because consumers demanded it AND the business model allowed companies to profit from it.

In Healthcare there still are no real consumers, despite the ACA and the patient engagement trend. We are still relatively powerless compared to our employer-sponsored insurance plans, the ACA insurance plans, and Hospitals.

While well intentioned, the ACA has done more to reinforce a lot of the same business models that led us to our problems today. The system still favors large-employers (and not individuals), people are seeing their out-of-pocket costs go up and finding narrow networks are limiting their choice. Patient engagement today is a high deductible plan.

Interoperability is a symptom (not the problem) of an aged business model. I'd be willing to bet the huge challenge of interoperability would be solved within a year if changes would ever come along to truly create an individual healthcare consumer.