Thought Leaders

Agreements can address a broad range of issues, including technical performance and customer-service responsiveness.

While Web-based applications proliferate and replace on-site, server-based software for critical business functions, healthcare organizations routinely secure commitments from vendors regarding application performance and reliability. After all, what good is an application if it is not available when you need it?

Healthcare organizations in 2008 that were eager to develop health information exchanges (HIE) and regional health information networks (RHIO) also developed creative ways to assemble requests for proposals (RFP); clarify vendor expectations, and manage and resolve governance issues. Vendors received RFPs from states that had high hopes for data interchange but minimal funding. Other ventures were stymied by unrealistic expectations and timetables for complex solutions involving physician and patient portals, e-prescribing and electronic health records (EHRs) in physician offices.

According to Susan Dentzer’s article "Reform Chronic Illness Care? Yes We Can," Health Affairs (Jan.-Feb. 2009), chronic illnesses account for 75 percent of total U.S. healthcare expenditures. Looking ahead, the challenge of caring for people with chronic conditions looms large. By 2020, the number of Americans with one or more chronic diseases will climb to about 157 million. That is when the shortage of physicians in the U.S. will reach approximately 200,000 and when the shortage of registered nurses could top 340,000, say David I. Auerbach, Peter I. Buerhaus and Douglas O. Staiger in "Better Late than Never: Workforce Supply Implications of Later Entry into Nursing," Health Affairs (Jan.-Feb. 2007). The combination of more and more patients with increasingly complex care needs and a shortage of clinicians to care for them could be devastating for the nation. Something has to change.

Only a small fraction of physicians use an electronic health record system (EHR) in their practices and many are low-tech. While health information technology (HIT) advocates often lament this fact, they miss the many good reasons physicians do not adopt the latest technology in their practices.

Ordering cheeseburgers at fast-food joints triggers more technology than getting a prescription written for Vicodin. Crazy? It’s also true. That was part of the U.S. Senate testimony offered by my colleague, Laura Adams, president and CEO of Rhode Island Quality Institute, during testimony to Congress on why ePrescribing’s time had come. I also testified and said the technology to handle such a need exists and has been proven for nearly a decade. We argued that not only is ePrescribing of controlled substances ready for prime time, it’s well past due. It can and should be legal for all major classes of drugs, including Schedule II narcotics; however, our government doesn’t think so — at least not yet.

Ten years ago I became CIO of CareGroup. On that day, I learned an important lesson about leading change. Just hours after getting the job I decided that we’d embrace a service-oriented architecture (SOA), standardize all desktop/server/storage infrastructures and implement centrally managed applications.

As the cost of healthcare continues on its upward trajectory, the calls for accountability grow louder. Consumers demand that care be affordable, accessible and of high quality. Providers believe that the system must provide them with fair reimbursement that is transparent and rewards good performance and quality of care. Payers want providers to practice the type of medicine that keeps patients healthy and meets medical necessity and appropriateness of care. So, who is ultimately responsible for the patient’s health? On whose shoulders does the effectiveness of the healthcare system rest?