An eWeek article describes a study highlighting and analyzing the correlation between healthcare IT excellence in the secondary/tertiary care hospital and its ability to reach patients using state-of-the-art information technology: 'Most Wired' Hospitals More Likely to Reach Patients at Home.
On the surface, this is a no-brainer - or as the hoi polloi would say, Duh! What caught my eye, though, is the key reason why this is so. Turns out it's not about the gadgets - its about organizational learning. If you are a bits-and-bolts guy like me, this should be a wakeup call.
Here's the tidbit from the eWeek article that got my attention:
Those in green eyeshades are also coming into their own. An article accompanying the survey concluded that the "most wired" hospitals do a lot of self-assessment. "The underpinning of this new and evolving discipline is measurement," said Solovy. Compared with other organizations, the "most wired" hospitals spend a lot more time evaluating their projects both before and after implementation. They are also more likely to have and test business continuity plans, such as having systems to rapidly restore clinical information systems even if a primary data center is lost. The typical "most wired" hospital implements rigorous evaluation plans for three-quarters of its top projects. These plans include determining when projects will be measured and when original objectives will be evaluated, plus establishing baseline metrics for financial, quality, safety or patient satisfaction.
That got me interested enough to find the original article. The study was conducted and reported by Hospitals & Health Networks, a trade publication rather than a peer-reviewed journal, but their methodology looks pretty thorough.
There's an article that summarizes the results, which starts with the following:
The nation's 100 Most Wired hospitals and health systems have, on average, risk-adjusted mortality rates that are 7.2 percent lower than other hospitals. The conclusion is valid at the 99 percent confidence level and remains valid even after controlling the data for the size of the hospital and teaching status.
The relationship between improved outcomes and information technology is documented in both the academic and practitioner research. But those studies typically examine the results of specific projects aimed at targeted safety improvements. This is the first analysis showing that hospitals with broad use of information technology across a variety of projects also have better outcomes. However, the analysis does not establish a causal relationship between IT and outcomes [italics mine].
'Scuse me? What does that mean? So I read on. A little ways down I found:
"IT is a contributor, but not an end unto itself. That's an important contribution of this work," says Carmela Coyle, senior vice president for policy at the American Hospital Association. "We are just beginning to understand the connection and contribution of IT to health care quality."
At AHRQ [the Agency for Health Research and Quality, a Federally-funded effort "charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans"], researchers routinely discuss whether IT is best used as a catalyst for systemic quality improvement or as a tool applied to individual quality and safety efforts. "We have a lively debate at the agency going on daily, almost hourly, about what is the right wedge to drive change," [AHRQ Director Carolyn M.] Clancy says, noting that views are strongly held on both sides.
"What this survey and analysis suggests is something more holistic," says Lewis Redd, Accenture's partner-provider practice leader. He says that technology plays a role in both targeted safety efforts and systemic change. "There's no doubt in my mind that these tools lead to better processes and better outcomes."
Hospitals are attempting both approaches--use of IT to eliminate specific errors and the application of IT for general improvements in care--often simultaneously.
The promise of specific technologies, such as order entry and bar code medication matching, is to eliminate specific types of medical errors. The promise of a more systemic approach including decision support, electronic surveillance and ubiquitous access to information is to increase the use of evidence-based medicine, clinical protocols and adherence to best practices, thus decreasing errors of omission and increasing the use of best practices.
So the real key to better quality is organizational change rather than deploying the gadgetry. A much, much harder and more subtle task.
Some CIOs say that the technologies, while promising, need to mature. Others say that the application of technology to changing hospital outcomes and, more broadly, improving population health, is a much steeper learning curve than ever anticipated.
"The holy grail is to deliver evidence-based medicine specific to the patient at the point of care to improve quality," says AHRQ's Clancy.
The take-away message I inferred from all this: "Programmers" beware. If all you do is code and don't care about what happens downstream, realize that someone in Bangalore, India, is doing that exact same thing for a quarter of the cost, work that used to be done by someone just like you. If you want to keep your career, and in the bargain help IT to make a difference in the excellence of your organization, recognize IT for what it really is:
"Technology is a tool to improve quality, but it is the people and the process of using technology that drives outcomes improvement [italics mine]," says C. Lynne Royer-Willoughby, a nurse and director of medical informatics at Community Health Network, Indianapolis. "IT is the means to the end, not the end."
So, in addition to learning that new programming language (e.g., Ruby on Rails) or technique (e.g., Ajax), you ought to be honing your skills in areas like contextual inquiry and human-computer interaction (HCI), and read everything Don Norman ever wrote (you can start with this essay).
Oh, and you might want to understand your end users better by learning everything you can about what it's like to work in a healthcare setting. Most such places gladly accept volunteers; for example, if you live in Boston, you could volunteer at legendary hospitals like Mass General or the Brig. If you live in the People's Republic of Ann Arbor, as I do, you could head for our Comprehensive Cancer & Geriatrics Center. You don't have to live near the center of the healthcare universe, though. Healthcare is ubiquitous, so you can even volunteer if you live in the middle of nowhere.
Real life is less predictable, more frustrating, but ultimately more satisfying in many ways than the admittedly addictive joy of programming (I, too, am a victim). It's where your end users live, though, and you might find that you like them better when you actually know them.
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