Ask the Experts
ral language processing, search engines and decision trees (business applications of many artifi cial intelligence con- cepts) are creating reference tools that trump anything previously available. Creative implementation of these technologies will enable the human mind to concentrate on the exceptional and the critical. The best technologies for healthcare are still in our future, but in the very near future. We will build them as the connections begin to spread over the next several years. It’s the aggregation of information, and ready but carefully authorized access to it, that will drive the development.
What do you see as the healthcare provider
organization’s biggest challenge in the next 10 years? How does it match or contrast with the CIO’s / IT department’s biggest challenge?
The most important change is the advent of the personal computer and its adoption in the industry. When I entered healthcare in 1988, PCs were not the standard. Many users in the hospital had terminals, but these terminals enabled access to the mainframe systems and nothing more. We didn’t have e-mail and no one I knew had ever heard of the Internet. The in- troduction of fi le servers, faster PCs, expanded memory and interoperability has enabled providers to employ best-of-breed applications from multiple vendors to meet their needs.
I believe the future will see a profound expansion in diagnostic testing systems and their ability to simu- late outcomes based on virtual procedures. This will enable the clinicians and physicians to determine the best course of action for treating conditions and predict outcomes more effectively. From a fi nancial perspective, provider organizations will need to ensure that benefi ts and payments are managed to the best possible level as higher co-pays become reality and we have more people assuming the responsibility of paying for their healthcare. Further, providers will need to provide more access via portals or Web sites to their patients to enhance the patient experience and effectively render their services.
Daniel O’Donnell Assuming that the ARRA/HITECH and other federal and local initiatives work as advertised and are expanded upon, the CIO’s greatest challenge will be helping to shape both the organizational and technical evolutions implied in the present initiatives. Right now, everyone agrees at a high level that costs should be better con- trolled and care should be coordinated. But getting
28 September 2010
from high-level aspiration to real practical change is complicated. Taking only a few steps in the direction of those goals exposes the confl icts, diffi culties and competing interests of many different players. Many of the underlying incentives in the United States reward ineffi ciency and inhibit true care coordination. The evolutions in organizational, cultural and fi - nancial systems, as with all evolution – intelligently designed or not – are diffi cult and disruptive. Advances in HIT, and increasing adoption, will make it obvious that most healthcare organizations are not structured to make truly informed planning and policy decisions involving both detailed clinical and business activities. Just as business and clinical departmental IT systems will become more integrated, the IT and clinical depart- ments must organizationally evolve to better coordinate their activities, make decisions and recommendations to senior management and fl exibly execute plans. This will require a better understanding of each other’s domains and an increase in staff members who have the ability to think and problem solve in both clinical and techni- cal domains. This is not to minimize the diffi culties inherent in specifi c IT system selection, implementa- tion, maintenance and training. But with the increasing need for the healthcare organization to function as an integrated and coordinated whole, the success of those specifi c tasks, and the coordination of clinical tasks, will depend on organizational change.
It will be interesting to see healthcare reform’s impact on the healthcare provider, with such poten- tially polarizing initiatives as achieving meaningful use. Increased fees on pharmaceutical companies and medi- cal device manufacturers will help fund the bill. The entities, in turn, will most likely pass those costs onto the healthcare facilities. Also, government payments to Medicare will be reduced. As the fl ood of newly insured patients enters and moves through the system, reim- bursement decreases while costs increase. That doesn’t leave a lot of wiggle room in an industry running on such small operating margins. Providers must either reduce services or eliminate more cost from the equation. The healthcare reform bill and ARRA/HITECH Act seem to be at opposition. Which will win? Those pro- viders likely to have success will be those with a head start that can leverage their healthcare IT investments to drive effi ciencies, improving quality and reducing cost while at the same time increasing service levels.
Clinical staffi ng shortages, combined with an in- creased population over the age of 65 and more cov- ered lives under the recently signed healthcare reform
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