Of Carrots and Sticks (and, Yes, Hybrid Cars)

June 24, 2011
Three recent news stories have particularly caught my attention in the past week or so; two are directly healthcare IT-related, while one is

Three recent news stories have particularly caught my attention in the past week or so; two are directly healthcare IT-related, while one is completely non-healthcare-related. Bear with me a moment while I describe them and then connect some dots of my choice.

On the healthcare IT-related front, first, Highmark Inc., the Pittsburgh-based Blue Cross Blue Shield plan, announced last Friday that it was moving forward with plans to provide grants totaling $29 million to help physicians in its market adopt EHRs and electronic prescribing software. Highmark officials announced that the health plan will pay up to 75 percent of the cost for physician offices to acquire, install and implement an EHR, up to a maximum of $7,000 per physician. Highmark is not the first regional health plan to try this, but the amount of money involved—and apparently the commitment behind it—is significant and worth noting.

Meanwhile, also on Friday, Sen. Max Baucus (D-Montana), chair of the U.S. Senate’s Finance Committee, on Monday introduced Medicare reform legislation (S. 3101) that includes several information technology provisions, including mandated e-prescribing for all clinicians reimbursed by the Medicare program, except for infrequent prescribers.

And, coming out of a completely different sphere of endeavor, on May 21, results were announced in the annual Challenge X competition, a contest co-sponsored by General Motors and the Department of Energy each year to encourage the next generation of automotive engineers to design the cars consumers will be driving in the future. Student teams from universities across the nation competed, with a team from MississippiStateUniversity taking first place (for the second time in a row), and a team from Wisconsin earning second place. The MississippiState team took a Chevrolet Equinox and created a parallel hybrid electric vehicle powered by a 1.9L GM direct injection turbo diesel engine, fueled by bio-diesel, achieving a 38 percent gain in fuel economy for the Equinox. The Wisconsin team created a similar parallel hybrid electric vehicle that achieved similarly big gains in fuel efficiency.

OK, so what do these news stories and developments have to do with one another? Simply put, they’re all about carrots and sticks. What’s clear with regard to the adoption of e-prescribing and EMR/EHR systems by physicians is that current market conditions are still not sufficient to prompt enough doctors to such systems on their own; they will need both financial incentives and (wisely conceived) policy mandates in order to make the shift. Though the technology is already more than adequate, and though the rationale for change is clear enough, financial concerns continue to trump the logic of progress in the physician e-adoption sphere. And that remains true on a lot of fronts even in hospital organizations. Purchasers, payers, and increasingly, consumers, are demanding that hospital organizations (and physician groups) move quickly to implement the tools of automation that will make patient care safer, of higher quality, more efficient, and more cost-effective. But the industry continues to struggle under a welter of divergent (and sometimes conflicting) financial, operational, and policy imperatives.

Perhaps the healthcare IT field could use something like a Challenge X competition for the best new ideas in facilitative technology? Yes, you say, there are already a number of annual awards programs that recognize promising new software products. But I’m thinking a bit bigger here. What if the federal government (perhaps through the same office that funds and manages the annual Baldrige Awards?) teamed up with a neutral, respected body within the healthcare industry to sponsor a very high-profile competition to stimulate and reward creativity in healthcare IT development and/or implementation? Maybe if the reward, and the recognition, were high-profile enough, it would generate more excitement among providers to compete to make game-changing leaps forward in IT adoption. In any case, from my standpoint, we collectively would have nothing to lose by trying something daring; we’re certainly not getting there fast enough the way things are unfolding now.

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