An article in the Harvard Business Review discusses what health care needs in the way of information technology transformation. (HBR Article) Now, I confess to being a little puzzled. I was under the impression that in the last decade we spent tens of billions of dollars forcing providers to adapt certain information technology, largely electronic medical records, so surely we have fixed all those issues. And billions more has been spent in the private sector on all manner of digital health, mobile apps, price transparency, etc., etc., etc. And we still have a health IT problem? How can that be? While the authors acknowledge these failures, their solution is largely more of the same. Make providers more beholden to technology, especially data collection and analysis, which inevitably results in more population-based, less personal health care. And it may not improve quality, as it forces everyone into one-size fits all guideline-driven care. I have written recently about an example of poor care delivered as a result of this approach, which also illustrated the immense burden placed on organizations to maintain and update the information in all these systems. The authors also tend to imagine that by citing a few success stories (at least apparent success stories) about use of HIT to reduce costs and improve quality, that those examples, which typically involve large, sophisticated organizations, can be replicated across the system. And many of these organizations are market dominant and have shown no inclination to share whatever savings they are achieving. Doesn’t matter if providers reduce costs but payers pay the same or more.
Color me unimpressed with Harvard’s so-called HIT transformation plan. Maybe the real problem in regard to cost, access and quality has nothing to do with inadequate IT. IT may facilitate solutions, but it probably can’t in any meaningful way change people’s behavior or improve the provider/patient interaction. In fact, I am convinced that it is the direct (in person or by communications technology) personal interaction of a provider with a patient that will do the most to improve quality of care outcomes and to ensure appropriate delivery of health services and products. So our IT efforts should be directed at supporting that interaction.