admin @ Mon, 09/10/2006 - 4:41am
“Chaos, total and utter chaos.” Says Dr Jeffrey Schaider talking about the transformation of Chicago’s Cook County Hospital from a paper based system to an electronic based system.
“Yet now that we’ve done it, what we’re finding is that the Doctors want more.”
It is the topic of the moment – when will Australia’s health care system become electronic and interoperable. And what is the best way to go about these things?
It’s a topic all the stakeholders in the West have opinions about. A lot of that opinion diverges on just what is the best approach for this Shangrila of modern health care.
“We’ve known it has been an attractive opportunity for quite some time now,” says Denmark’s Professor Christian Nohr. “But it seems we’re unable to decide on just when or how we want to get it.”
Dr Barry Blumenfeld, Clinical Health Informatician for Partners HealthCare in the US, sees some measure of the slow pace of change as reflective of the way health industries evolve.
“Look, the cost savings are going to be enormous,” says Dr Blumenfeld. “We’re looking at somewhere in the order of up to $78 Billion USD a year… the potential savings could be significant.”
However Dr Blumenfeld sees part of the problem lying with vendors.
“There’s a lack of vendor desire to becoming more interoperable. It will make them more of a commodity. In that regard you can understand their reluctance to developing products that can be used between systems.”
But Dr Blumenfeld believes one way or another “we have to achieve interoperability.”
He highlights his own experience in the Partners system in the US.
“While Partners has some of the most advanced workflow and clinical decision support systems in the US, they are sometimes poorly integrated…like our computerized physician order entry (CPOE) systems. At five of our academic medical centers we have five different systems – they’re all incompatible!”
Dr Blumenfeld applauds the work being done by NEHTA in developing a Standards Based Approach.
“The traditional way – integration of systems, mapping between systems, well, that type of integration proves to be very expensive.
“The other way is to use standards. You could say heart attack, I could say mild cardial infarction, but either way they’d both have a code of ‘123’.
“Using standards to achieve interoperability, you still have to create connections between systems but because they are based on standards the cost of achieving this is so much less.
“If you adopt standards then, in effect, everyone is speaking the same language.” Says Dr Blumenfeld.
Susan Hyatt, President and CEO of HyattDIO Corp, and the CEO of Health Infoway, takes a different view than Dr Blumenfeld.
Infoway, Canada’s platform for the development of a basic interoperable health record across Canada was instigated in 2001, with an operational target of 2009.
“It’s not the technology that’s the issue it’s the management of the change that goes on around the technology. It’s the creation of the vision. Transforming the way you do business as you implement the technology you change the ways that people work and you change the ways that people work in the future and that’s all about the management of change.”
If Ms Hyatt had to do it all over again she says she would re-evaluate how the money would be spent.
“How much money would you put to tech and how much money would you put towards the management of change? I’d say 80% of that should go towards the management of change and 20% towards technology – it’s a huge difference.”
Dr Nohr has traced the history of technological advancements in health informatics and believes what is frustrating people in the industry is the continual promises that are being made and then broken or forgotten about.
“I have traced back to ‘68 – when studies about GP computers were saying in two years – patient information will appear on the screen in a fraction of a second. That was the idea. (There’s) a whole collection of these articles and they’re all saying within two years.”
“Two years, it always seems to be in two years,” continues Dr Nohr perplexed by the promises being made.
“I don’t know how we are keeping up this optimism. People think information technology is the solution to all the problems in the world. It’s the ‘we just need a little bit of software and then we’ll have it’ idea.”
Dr Nohr believes this is a problem because if promised IT solutions are always two years away, failures mount and frustration, in light of the targets announced, will inevitably build.
“Distinguish between the political arena and the health informatics arena – don’t get them confronted.” Says Dr Nohr.
“We need to harmonise the political goals with the health informatics goals.
“It’s a lot more difficult to predict when the people will collect benefits. Some people say it will take two generations – maybe that’s a lot more accurate.” Says Dr Nohr.
Now that the electronic systems have been rolled out in Cook County Hospital, Dr Schaider has been able to track the benefits.
“(Previously) I couldn’t measure the difference in anything before. I didn’t know what my length of stay was; I didn’t know how long after arrival it took for someone to see a doctor. I can measure all of that now.” Says Dr Schaider.
“Its hard to take that first step, once you start moving you can still change it, you can till adjust it but if you never start you never start and you could delay it for a long time.”
Dr Schaider’s experience in Chicago was one of getting things started and throwing caution to the wind.
“We have three hospitals in our system, one of our hospitals said we want to be last (in the rollout). In the first three months that was the smartest decision they made. But now four years later – they’re not rolled out yet. They’re dying because they see all the functionality that we have that they don’t have. They’ve had three years without the system which they can see now as a problem.” Says Dr Schaider.
“You hear from a lot of people that it’s got to be perfect – well how about this, just start!” Says Dr Schaider.
“Yet now that we’ve done it, what we’re finding is that the Doctors want more.”
It is the topic of the moment – when will Australia’s health care system become electronic and interoperable. And what is the best way to go about these things?
It’s a topic all the stakeholders in the West have opinions about. A lot of that opinion diverges on just what is the best approach for this Shangrila of modern health care.
“We’ve known it has been an attractive opportunity for quite some time now,” says Denmark’s Professor Christian Nohr. “But it seems we’re unable to decide on just when or how we want to get it.”
Dr Barry Blumenfeld, Clinical Health Informatician for Partners HealthCare in the US, sees some measure of the slow pace of change as reflective of the way health industries evolve.
“Look, the cost savings are going to be enormous,” says Dr Blumenfeld. “We’re looking at somewhere in the order of up to $78 Billion USD a year… the potential savings could be significant.”
However Dr Blumenfeld sees part of the problem lying with vendors.
“There’s a lack of vendor desire to becoming more interoperable. It will make them more of a commodity. In that regard you can understand their reluctance to developing products that can be used between systems.”
But Dr Blumenfeld believes one way or another “we have to achieve interoperability.”
He highlights his own experience in the Partners system in the US.
“While Partners has some of the most advanced workflow and clinical decision support systems in the US, they are sometimes poorly integrated…like our computerized physician order entry (CPOE) systems. At five of our academic medical centers we have five different systems – they’re all incompatible!”
Dr Blumenfeld applauds the work being done by NEHTA in developing a Standards Based Approach.
“The traditional way – integration of systems, mapping between systems, well, that type of integration proves to be very expensive.
“The other way is to use standards. You could say heart attack, I could say mild cardial infarction, but either way they’d both have a code of ‘123’.
“Using standards to achieve interoperability, you still have to create connections between systems but because they are based on standards the cost of achieving this is so much less.
“If you adopt standards then, in effect, everyone is speaking the same language.” Says Dr Blumenfeld.
Susan Hyatt, President and CEO of HyattDIO Corp, and the CEO of Health Infoway, takes a different view than Dr Blumenfeld.
Infoway, Canada’s platform for the development of a basic interoperable health record across Canada was instigated in 2001, with an operational target of 2009.
“It’s not the technology that’s the issue it’s the management of the change that goes on around the technology. It’s the creation of the vision. Transforming the way you do business as you implement the technology you change the ways that people work and you change the ways that people work in the future and that’s all about the management of change.”
If Ms Hyatt had to do it all over again she says she would re-evaluate how the money would be spent.
“How much money would you put to tech and how much money would you put towards the management of change? I’d say 80% of that should go towards the management of change and 20% towards technology – it’s a huge difference.”
Dr Nohr has traced the history of technological advancements in health informatics and believes what is frustrating people in the industry is the continual promises that are being made and then broken or forgotten about.
“I have traced back to ‘68 – when studies about GP computers were saying in two years – patient information will appear on the screen in a fraction of a second. That was the idea. (There’s) a whole collection of these articles and they’re all saying within two years.”
“Two years, it always seems to be in two years,” continues Dr Nohr perplexed by the promises being made.
“I don’t know how we are keeping up this optimism. People think information technology is the solution to all the problems in the world. It’s the ‘we just need a little bit of software and then we’ll have it’ idea.”
Dr Nohr believes this is a problem because if promised IT solutions are always two years away, failures mount and frustration, in light of the targets announced, will inevitably build.
“Distinguish between the political arena and the health informatics arena – don’t get them confronted.” Says Dr Nohr.
“We need to harmonise the political goals with the health informatics goals.
“It’s a lot more difficult to predict when the people will collect benefits. Some people say it will take two generations – maybe that’s a lot more accurate.” Says Dr Nohr.
Now that the electronic systems have been rolled out in Cook County Hospital, Dr Schaider has been able to track the benefits.
“(Previously) I couldn’t measure the difference in anything before. I didn’t know what my length of stay was; I didn’t know how long after arrival it took for someone to see a doctor. I can measure all of that now.” Says Dr Schaider.
“Its hard to take that first step, once you start moving you can still change it, you can till adjust it but if you never start you never start and you could delay it for a long time.”
Dr Schaider’s experience in Chicago was one of getting things started and throwing caution to the wind.
“We have three hospitals in our system, one of our hospitals said we want to be last (in the rollout). In the first three months that was the smartest decision they made. But now four years later – they’re not rolled out yet. They’re dying because they see all the functionality that we have that they don’t have. They’ve had three years without the system which they can see now as a problem.” Says Dr Schaider.
“You hear from a lot of people that it’s got to be perfect – well how about this, just start!” Says Dr Schaider.