HITECH's Impact on "Whack-A-Mole" Healthcare Delivery

We all remember the game “whack-a-mole”.The player holds a padded mallet while waiting for one of several moles to raise its head through a hole in a platform.Points are scored if the mole is “whacked” by the player before it disappears below the platform.Unfortunately, as we all remember, it is virtually impossible to “whack” all the moles simultaneously.One mole distracts our attention while another pops up on the other side of the platform.

The healthcare delivery system has evolved much like a giant “whack-a-mole” game. The prevailing model of care delivery has been for hospitals to focus on the facilities, technologies and support resources of care while physicians determined both the supply and demand for medical services. As we work to “whack” poor performance or negative outcomes problems pop out in another part of the system.

Saturday, during the President's weekly address, released while he was in France for the 65th anniversary of D-Day, Mr. Obama focused on health care, citing the crippling effect soaring costs have on the nation's economy as the reason why reform cannot be delayed. "The status quo is broken," he said, while warning that the current system could collapse if nothing is done to control spiraling costs. "[If] we do nothing, everyone's health care will be put in jeopardy." Peter R. Orszag, Director of the Office of Management and Budget indicates that “health care reform will have two components: cost containment provisions and expanded coverage. In the near term, the impact of expanded coverage will temporarily dominate. Overtime, however, the impact of the cost containment provisions will accumulate, and the net impact will be a reduction – and perhaps a dramatic one – in government spending.” Many experts agree that the HITECH Act is a cornerstone of the commitment to reform provider payments and push transformation in the nation's healthcare system. As we look beyond the HIT industry’s obsession with “meaningful use” and certification, the HITECH Act alludes to the role of technology in pushing transformation in three critical areas:

Comparative Effectiveness: A comparison of the impact of different options that are available for treating a given medical condition for a particular set of patients. The analysis may focus only on the relative medical benefits and risks of each option, or it may go on to weigh both the costs and the benefits of those options
Information Exchange for the Purpose of Improving Care Coordination: The eligible professional demonstrates to the satisfaction of the Secretary…that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care
Expanded Clinical Quality Reporting: “Meaningful use” must include submitting information ‘in a form and manner specified by the Secretary’ on such clinical quality measures and such other measures as selected by the secretary

The greatest challenge in addressing any of these transformation drivers is our current “whack-a-mole” approach to managing the care process. Most notably, the lack of integration of hospital and physician work processes. The healthcare industry must design a “system of care” – one where each part is interrelated, organized and integrated to accomplish specific goals. From a HITECH perspective, this means hospitals must move beyond a focus on CPOE to take responsibility for health information exchange for the purpose of outcomes management both within the acute and ambulatory settings. Health information exchange across provider sites has the potential to create significant benefits including:

Quality of care improvement through improved access to data
Reduction in costs through efficiency, effectiveness, productivity gains and avoidance of redundant provider services
Improvement in the patient experience resulting in higher “customer satisfaction”
Enhancement of compliance with legal, accreditation and standards of care practices
Expanded market share with potential for new revenue streams

Technology alone will not make this happen. We must deliberately design new integrated systems of care. Rather than letting the system evolve organically as it has in the past, we must use “systems thinking” approaches to consider the entire care process—from the technology and interventions used, the human resources and their respective roles, the location of care is delivered, the decision making and management philosophies applied, the patient segments served, the order and sequencing of tasks and the incentives required. Until physicians and hospitals align their goals, and collaborate to integrate care processes; we will continue to play “whack-a-mole” healthcare.