Jul 21 2004

The National Health Emperor Has No Clothes

Published by at 6:04 pm under patient safety

National Heatlh Information Infrastructure 2004 Conference was just held last week in Washington, DC:

“In an Executive Order issued on April 27, 2004, President George W. Bush called for widespread deployment of health information technology within 10 years. As part of this announcement, he formed the Office of the National Coordinator for Health Information Technology (ONCHIT). An important aspect of the President’s initiative is the development of a nationwide interoperable health information technology infrastructure that can facilitate improvements in safety, quality, efficiency, and care coordination.”

This is my old briar patch, having spent 30 developing two of the largest hospital information systems in the world, for the Veterans Administration and the Department of Defense hospitals world wide.

I really am trying to be optimistic about this, and all of the surface rhetoric is great, about improving care, “tipping points” and all that.

However, I am greatly concerned that the deep structure of our health care system – the structures which have lead it to become an industry whose preventable errors are now one of the leading causes of death in America – are are still very much at work. Making the forces of this deep structure more “efficient” with “improved” information technology could easily end up making things get worse faster.

Our doctors have 1.2 million terms for how to be sick, yet virtually none to describe health, a list that is growing 5% per year.

We have a disease industry, not a health care sector. It is based on supply and demand of disease. Regardless of whatever nice, soft images your local hospital might put on billboards, their business is for you to be sick enough to come there.

A hospital that invests in a patient safety system which reduces readmissions would see its revenues drop, forcing them to be “altruistic” to save lives. The grocery industry has been using bar code scanners for decades for cookies and magazines; medicine is just now moving towards them – for drugs which have life-threatening consequences. Why has this taken so long? (And why are they moving to paper-based labels instead of RFID?)

Every provider and organization in the US probably has a vision statement which includes something stating that they are “patient centered.” The subtext of this should read, “You come first, after me.” The organization is at the center of their world, the patients are at the periphery. The standardization process, HIPPA, and a whole zeitgeist are structured around stovepiped, organization-centric models to which the patient is peripheral.

In our litagous age, the value of a wide spread electronic record would be far greater to malpractice lawyers doing Monday morning quarterbacking than doctors improving our health. This will lead to an upsurge in defensive medicine, as docs are drawn to ever-greater scrutiny. I suspect that these investments are little more than an income transfer scheme from health care to the trial lawyers. The chances of improving our health in all of this.

I wish I could imagine otherwise, but it sure seems to me that we are trying to get out of hole by digging it deeper.

For some of my musings on how to get out of this hole, see HealthSpace , Health and the Devil’s Staircase, A Transformational View of Health, Towards a Language of Health, and Creating an Epidemic of Health.

P.S. Very little of this rant applies to the VA health care system, largely due to the fact that their “deep structure” is aligned – they really do benefit from having healthier vets.


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