The national effort to “e-enable” the healthcare industry is unprecedented in scope. Fully $50 billion has been made available through ARRA for broadband infrastructure, standards, outcomes research and incentivizing healthcare organizations and providers to become “meaningful” users of certified information technologies. This, not to mention the billions more in private sector leveraging happening right now through telecommunications providers, hardware and software companies, consulting firms and others working to promote health IT.
Medicare and Medicaid are projected to outlay more than $33 billion over ten years. More than $ 7 billion in government funding is available for infrastructure build-out. The Agency for Healthcare Research and Quality, NIH, and National Institute for Standards and Technology are spending billions for comparative effectiveness research, bioinformatics, and standards development.
The Office of the National Coordinator for HIT has already allocated close to $2 billion in discretionary funding for Regional Extension Centers, State-based Health Information Exchange assistance, Beacon Community efforts, Community Health Center adoption, as well as training a much needed HIT workforce.
In some ways the healthcare field was caught by surprise given the magnitude of the effort. Timelines are short, expected results are ambitious, and the field is especially strapped right now given all of the requirements of both HITECH and now much broader healthcare reform. All of which begs the following question: Are we doing everything we possibly can given available resources to ensure success as measured by improved patient-care outcomes and a more efficient healthcare delivery system ?
In some obvious ways I think the answer is yes. There is something deadly serious about a $50 billion commitment by Congress and the Administration. Given this impetus, the burden now rests with providers, vendors, consumers, and insurers to “make it happen”.
And yet, more could and should be done.
Financial incentives (the carrot and stick approach under Medicare and Medicaid) are helping to move us forward at lightning speed. The “heavy lift” is well underway. This top down macro approach provides both the funding and the policy needed to move ahead quickly.
At the same time consider a May, 2010 Wired magazine article entitled: Cognitive Surplus: The Great Spare-Time Revolution featuring an interview with two writers (Clay Shirky and Daniel Pink) steeped in technology, business, and society. In his recent book “The Surprising Truth About What Motivates Us” author Pink “dig(s) through five decades of behavioral science to challenge the orthodoxy that carrots and sticks are the most effective way to motivate workers in the 21st Century”. Instead he argues convincingly that we are mostly driven by things that satisfy us. For his part, Shirky says that a tremendous amount “surplus” time that Americans once spent watching TV has been redirected “toward activities that are less about consuming and more about engaging – from Flickr and Facebook to powerful forms of online political action”.
Enter Andrew McAfee, the MIT Center for Digital Business guru who coined the term (and now book) Enterprise 2.0. McAfee concludes that: “Thanks to a new class of collaborative technologies, organizations can now leverage information in valuable new ways, including: capturing accumulated knowledge, connecting employees who need information with the experts who have it, and enabling the best ideas to emerge organically”. McAfee isn’t blowing smoke. He cites several real world business examples of organizations large and small including; Google; the British Broadcasting Company, and even the Central Intelligence Agency (post 911), that have transformed some of their key practices using Enterprise 2.0 tools.
Pink, Shirky and McAfee are pointing us to some new approaches. Simply we should be using the very same information technology tools that we are planning to deploy throughout our largest industry to help get us there. My friend and colleague David Hartzband, Ph.D. Of MIT and the RCHN Community Health Foundation summed it up best to me when he said: "I totally get it. We need to be eating our own dog food !"
Some concrete examples a little closer to home ? On the clinical front, just last week it was reported in iHealthBeat that an NIH-funded University of Wisconsin-Madison study has been looking into Facebook data for the correlation between on-line references to alcohol consumption and actual drinking habits. Researchers are also studying the willingness of patients to allow their physicians the ability to use online social networking profiles for clues about their health status.
Consider for a moment how “crowdsourcing” is now being applied in medicine. Slate reported recently that “crowdsourcing” is offering physicians a new way to collaborate and seek advice on challenging medical issues. iHealthBeat further reports that the New England Journal of Medicine “hosts a weekly challenge inviting readers to select a diagnosis based on an image posted online. The journal also polls readers for input on challenging treatment questions and compiles responses from nearly 20,000 doctors from around the world”.
Are researchers and clinicians ahead of administrators and health policy makers in this regard ? Probably. We should be working quickly to “aggregate’ the many communities of interest (the score of affinity groups including physicians, BMEs, CIOs, Planners etc.) in support of Telehealth / EMR / HIE adoption.