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Tradition Grapples with Insatiable Demand

by John Moore | June 05, 2008

Dan Nigrin, the CIO from Children’s Hospital Boston set the tone at this morning’s meeting stating what keeps him up at night is struggling with the insatiable demand for HIT among care providers (espeically newer and younger staff members) at Children’s while concurrently dealing with an industry that is so bound by tradition. On one hand he must prioritize spending across any number of categories that he characterized as infinitely long (healthcare still spends a woefully low 1-3% of revenue on IT, as a comparison, manufacturing is spending between 4-6% and financial institutions spend even more). Yet on the other-hand, he needs to find new ways to more effectively leverage this spend to insure effective adoption occurs. Not an easy task in this tied to tradition industry.

And what might some of those spending priorities be? John Halamka, the other CIO on the panel gave quite a laundry list that includes:

  • Getting non-affiliated doctors on-board in using an EMR throughout the New England region. He did a recent post on that one.
  • Addressing the demand for data storage. Demand now far exceeds his budget despite Moore’s law and he sees no slow down for the foreseeable future.
  • Insuring secure communication throughout the network.
  • Tackling security. They push back an attack on their system every 7 sec. (BTW, that works out to be some 12,300 attacks per day, or 4.3M/yr). While Halamka is using various commercial Spam filters, unfortunately these solutions today are too restrictive. Why? As it turns out, physicians use a lot of anatomical terms that Spam filters readily tag. He has 4 FTE on staff doing nothing but IT security.
  • Providing the best decision support tools at the point of care. The knowledge is coming in so fast and furious, he does not see any single entity being abl to address it. Recommends a “knowledge cloud” model.
  • Compliance – never ending list to contend with that seems to only grow over time.
  • Creating dynamic websites (internal & external facing) using new tools (ala Web2.0). This summer they will release new portals that incorporate social networking, dynamic content, etc. to create a richer, more cogent user experience.
  • Disaster recovery – 4x redundancy is the norm for his operations.

At one point during the first session, conversation veered off into the old, what about RHIOs. Conversation concluded when one of the panel members simply stated that even a successful RHIO, of which there are few, will struggle to stay afloat as there is not enough “low hanging fruit” for them to address that will sustain them long-term. That statement ended the conversation on RHIOs.

During the Q&A for the first session I shot up my hand and asked what about Pay for Performance (P4P), quality and pricing transparency (was quite surprised that this was not keeping them up at night, plenty of other CIOs are reporting otherwise). Both stated that yes this is a big issue and continues to drive many of their priorities. Halamka made mention that one P4P initiative represented some $22M to BI, so quite obviously, it became the number one priority for his group. I bet he’ll be seeing many more P4P initiatives in the future as this issue is not going away, only growing.  Maybe next year he’ll report that it is keeping him up at night.

The second session of the event focused on consumer healthcare IT. Again, most of the discussion was dominated by the two CIOs on the panel.

Both Halamka and Nigrin are in full support of the PHR concept and complete consumer control of their own record. Each are taking steps at their respective institutions to make that happen.

At Children’s they are still in the process of rolling out the PHR across the various practices, having only started the roll-out recently. They are using their home-grown solution, Indivo, which is the same solution underlying Dossia. In speaking with Nigrin after the event he stated that they are predicting relatively high adoption rates as in Nigrin’s words “there is no one more motivated than a parent caring for their child with an illness”.

Over at Beth Israel (BI), they have provided consumers with the tethered PHR portal PatientSite for several years. Halamka stated they get 40,000 visitors/month to the site. At BI they make it mandatory that all MS patients use PatientSite to facilitate care. Among primary care physicians (PCP), roughly 30% of PCPs are using a PHR with their patients. Another interesting point he made was that they have not actively pushed the PHR concept on many of the specialists at BI as they often only address episodic care events. Thus, chronic care specialists and PCPs are the focus for internal PHR adoption and use.

As part of their commitment to patient control of medical records, Halamka stated that they will interface to any leading Personal Health System. They have enabled Google (though reports are it is extremely limited version of one’s record), are working through the final steps to enable HealthVault and they are currently working with Dossia as well. While they may have gone live first with Google, there does not appear to be any overt favoritism.

Nearly universal belief among all panel members (to which I concur) that we are very early in the adoption and use of PHRs and it is difficult to say today how all this will play out. Patrick Boyle from IBM and David Hendren from Catalyst Health Ventures both stated that the current healthcare system is seriously broken, costs are unsustainable and drastic changes are needed. Part of the solution will be for the consumer to take a more direct and active role in managing their health. Boyle went on to relate how IBM has been using its internally hosted PHR (happens to be WebMD based) to drive down their healthcare costs, which are currently about half of the industry average with big savings coming from their ability to negotiate better rates with insurers. With the practices and incentives they have implemented at IBM via the PHR, they are able to go to insurers and provide clear evidence that IBM employees represent a lower health risk than say some company that does not provide such tools to their employees. IBM’s success has not gone unnoticed and is just one factor in the large ramp-up in PHR activity among employers, an issue covered in depth in our recent PHR Report.

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