Success with Health IT Requires Buy-in, Not Just Budget

I have been in information technology (IT) and automation for over 30 years in a variety of industries, and in healthcare IT for the past decade. So I have seen my share of the good and bad in IT.

In most industries, IT has gained widespread adoption, revolutionized operations, and increased productivity and efficiency. Unit output per worker, and the quality of that output, is measurably better, even in the brick-and-mortar world. Checkout at the grocery or hardware store is so simple and automated that we can do it ourselves - which saves us both time and money. Bar code scanning and price databases have greatly eliminated errors and "Price check on register eight" episodes. When we go to the airport, airline counter kiosks speed us through the check-in process in record time, even though the number of passengers has more than doubled and the number of employees is about one-fourth of what it used to be. Most industries are on their fourth or fifth generation IT systems, wringing the next few percentage points of efficiencies out of their systems.

In healthcare, on the other hand, even five years after ARRA/HITECH promised unprecedented billions of dollars to upgrade EMRs to EHRs, there are still many pundits who argue whether IT even has a place in healthcare. They claim that healthcare is too complicated, too fragmented, and too full of disparate processes and data types to lend itself to digitization and automation. Most healthcare entities are on their first generation systems, and according to two reports from Health Information Management Systems Society (HIMSS) Analytics, fewer than 5 percent of hospitals and barely 5 percent of practices in the US have achieved the highest level of adoption, implementation, and optimization of EHR systems. 

So in consequence, when we go to the doctor's office we are still typically faced with the proverbial clipboard at the check-in desk, and then when we are referred to go to the lab or imaging center or another clinic, we have to manually recreate our health history from memory for the umpteenth time.

Many healthcare software vendors claim their systems reduce costs and improve patient care, and point to statistics and case studies that supposedly prove their point. Early adopters and clinicians from mature, well-run healthcare IT system implementations are featured at national healthcare conferences, with almost rock-star type status. Indeed, I have met many clinicians and staff who work for organizations that have overcome the "digital divide" and have become highly automated, and if you ask them if they would ever go back to paper, they scoff at the idea.

The 'Cons' Need Context
The literature is also full of negative news about IT and EHRs, with headlines and content - much of it anecdotal - about the negative effects of technology in healthcare. If you ask almost any physician if they have had a negative experience with their technology, or know someone who has, the answer will be yes at least 90 percent of the time. And at these same conferences featuring the healthcare technology believers, there is a persistent whisper in the audience of incredulous disbelief. And sometimes during a Q&A session, I've seen the whisper essentially erupt into a debate between believers and non-believers.

But much of this view has to be taken with a grain of salt, as the information is frequently taken out of context or without all the facts.

Indeed there was = an article a few years ago that implied $120,000 in EHR costs, with the primary culprit being lost revenue. But if you read the actual article, it was not based on experience, it was based on a survey of physicians who were considering adoption of an EHR, and whether they expected to see a drop in productivity. So although it was technically a statistical study, it was based on opinion, not on fact.

Clearly there is a self-fulfilling prophecy concept here. If you expect something to be bad, it probably will be.  

What is the source of the data supporting the naysayers? Are there data to back up the horror stories of physicians leaving in droves, or shutting down their practices, to either avoid going the IT route, or in response to an IT disaster?

It is a fact that there have been many well-publicized IT failures in healthcare. What is not widely appreciated is that across all industries, IT projects have a failure rate that some experts believe could be as well over 10 percent. (A failure in this context generally understood to mean that the implementation failed to meet expectations in all three areas: time, cost, and user requirements. In roughly another significant percentage of cases, the system implementations are not fully successful in one of these key areas, but at least the implementations were somehow rescued rather than abandoned.  

Here are many well-known examples in literature. The industry journal CIO (Chief Information Officer) has published a top 10 List of IT disasters, costing companies like Hershey Foods and jeweler Shane Company millions, but none of them were in healthcare.

The literature is also full of root-cause analyses and case studies of these and many other failures, and essentially all of them point to improper executive and organizational buy-in, lack of proper planning, poor user training and implementation, failure to develop requirements and matching them with systems capabilities, and dealing with the impact of changes to the organization.

These are all major factors in healthcare, so for healthcare IT projects to have even half a chance to be successful, it needs executive and organizational buy-in to even start.

So, as a pro-technology, pro-EHR, pro-automation expert, my advice to reluctant physicians and practice executives who are considering an EHR is simple: Don't do it. If you don't believe it will work, it won't work.

On the other hand, with proper buy-in, good user requirements matched with a good vendor product, proper budgeting, planning, and implementation, healthcare IT can be a real game-changer, and can definitely contribute positively to the three pillars of the Institute for Healthcare Improvement (IHI) triple aim: lower costs; better outcomes; and improved health of patient populations.