Alice had a rabbit hole, Harry had a flying car and Peter, Susan, Edmund and Lucy had a magic wardrobe. For David Brailer, M.D., Ph.D., it is a window. "We have a magic window," the physician and national coordinator for health information technology told a standing-room-only audience at the American Medical Informatics Association last fall. "My advice is take advantage of it right now....It's not going to last."
The visual is enchanting, but Brailer makes an important point. Although consensus and support for healthcare IT initiatives are strong, they won't last forever. The public is easily distracted from complex issues such as healthcare reform, and, without continuing pressure, congressional attention is likely to falter as well. The fresh wind of optimism and hope blowing through this window is stirring up paper-based processes and perceptions that have remained relatively stagnant for the past 50 years. And the wind also brings change. Few can argue with the ultimate goal of delivering better quality healthcare, but cultural transformations are often as challenging as they are exhilarating. And, as Brailer points out, the debates among stakeholders are not about what, they're about how.
There are plenty of supporters for the national health information infrastructure, but, whereas encouragement has been plentiful, funding has not. And cost continues to pose the primary barrier to just about every initiative proposed--big and small. The federal government has primed a number of these pumps through its agencies and has a portfolio of demonstration projects under way.
But some industry experts are concerned that technology, and its role as change agent, is being overhyped. Among them is Palo Alto, Calif.-based futurist Ian Morrison, who warns that the public's expectations of technology's potential is becoming much too high. To effectively and efficiently manage patients' health issues will require implementing electronic health records across the continuum of care--a feat not to be underestimated. Another difficulty, he cautions, is that savings will accrue slowly--a fact likely to disillusion those counting on a quick return on investment.
Some have declared the industry at the "tipping point," implying that widespread adoption and implementation are imminent. Can nirvana--with streamlined and cost-effective care delivery, lower healthcare costs and higher quality of care--be at hand? That's a tall order for a country that continues to occupy the embarrassing position of the biggest spender among industrialized nations while realizing the lowest returns: higher rates of medical errors, lower life expectancy and higher infant mortality, as reported recently by the New York-based Commonwealth Fund.
It is generally accepted that the federal government's leadership is necessary to achieve the collaboration required for a national data-sharing network, but the private sector is clearly capable of much more than it has done--or been credited with. When Hurricane Katrina destroyed thousands of individuals' medical records, for example, it was the private sector that developed the plan to derive medication histories from claims within days after the disaster. Sadly, government approval delayed rollout of the KatrinaHealth project by weeks.
During this process of transformation, it will be important to herald the small victories and successes and to support those in public and private leadership roles with the expertise, commitment and passion to bring about healthcare's transformation. Like the mechanisms used by Alice and the other fairy tale characters to launch their dream lives, the magic window that Brailer refers to is merely a metaphor. But the changes that can be made on the "other side" are very real.
