Rush to Reform

I haven't posted for awhile -- mostly because I have been busy with customers, development projects, and the impact of the economic crisis -- but also because I’ve felt that there has been so much noise and anticipation around the priorities of the incoming Administration that reading seemed more valuable than posting.

It is clear that 'reforming the health system' is a priority -- and that’s positive.   Daschle has promised lots of conversations in homes around the country on this important topic, which may be illuminating and instructive for all (or not).    Certainly the industry stakeholders -- executives, pundits, vendors etc. -- are all lining up their policy principles, suggested areas of priorities, options for reform and the like. You can read them everywhere--in the news, at conferences, and in blogs.

In the current bailout climate, which I fear is corrupting the minds of many otherwise thoughtful people; the risk of well intentioned changes having negative unintended consequences (economic sink holes as well as lack of systemic improvement) is high.  

Despite the risks, I remain encouraged that some positive things can happen.   No matter what priorities and tactics within health reform are chosen, substantial health information technology will be a necessary ingredient.    There is a growing consensus that increasing health data liquidity/exchange is the first order priority (see here and here for recent examples). This is the position we staked out three years ago, and the ongoing focus of our investments. 

Refactoring the question of HIT and health reform from "subsiding EMR adoption" to "incenting the use of shared data and personal, connected tools to improve care" is real progress.   There is lots of valuable electronic health data today. The first investment priority should be to get more value (reuse vs. re-create, physician/consumer access and use of data in decision making) out of what exists already, instead of funding more source systems..

My last thought for the morning on HIT and health reform isthat the technology question should also be refactored.    Rather than focusing on infrastructure investments(more EMRs, more HIEs, build it and they will come dreams here-- this is input focused), the appropriate focus should be choosing an outcomes goal -- say reduce diabetes by 50% in 5 years.   Let innovative people inside and outside the industry pull the right technology into adoption to meet an ambitious goal.   Yes, changes in reimbursement need to happen for this to work, but this is true in all cases.    The technology exists today. The real adoption challenge is not about incentives to buy it, but rather about rewarding those who use it well to achieve better outcomes -- for patients, for themselves and for payers.

Comments

• Anonymous
  December 17, 2008
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