When Technology Is the Follower—and Leadership Is… Well, the Leader

March 30, 2014
A panel discussion held March 26 during the iHT2 Health IT Summit in San Francisco helped to underscore how vision, leadership, and strategy need to come first in informing IT strategy and implementation

A panel discussion at the Health IT Summit at the Presidio Golden Gate Club in San Francisco, presented by the Institute for Health Technology Transformation (iHT2) on Wednesday morning, March 26, reinforced everything I’ve been hearing and reporting on, around population health recently. The event, which has been focusing strongly on population health, analytics, health information exchange, and patient engagement, has been engaging attendees in discussions that range far beyond IT operations issues. (For purposes of disclosure, iHT2 has since December has been a partner with Healthcare Informatics and its parent company, Vendome Group LLC.)

And Wednesday morning’s panel discussion absolutely reinforced what has been a running theme at this event, as well as at other events in the healthcare and healthcare IT worlds recently—and that is that, when it comes to the shift towards what we at Healthcare Informatics have been calling “the new healthcare”—the transformation of the current U.S. healthcare system into a system with greater patient safety and care quality, greater accountability and transparency, greater cost-effectiveness, accountable care, population health, and so on)—it will be vision, mission, strategy, and leadership that will drive change, with information technology an absolutely vital facilitator, but with the vision, mission, strategy, and leadership coming first.

All of that came to the fore Wednesday morning, as Lynne Dunbrack, research vice president at IDC Health Insights, moderated a panel that included Howard Landa, M.D., CMIO at Alameda Health System; Mark Zirklebach, CIO, Loma Linda University Medical Center; Charlotte Wray, chief clinical and information officer, and clinical operations and information systems, at University Hospitals Elyria Medical Center; and John McDaniel, national practice leader, US Healthcare Provider Market, at NetApp.

As Dr. Landa noted, IT will naturally follow strategy when it comes to population health. A very core imperative? To reach out. “Being proactive and reaching out to patients will lead to dramatic gains in population health,” Landa asserted. Meanwhile, all those on the panel agreed that healthcare organization leaders will need to help guide their patients with chronic illnesses into programs emphasizing healthy living and healthy diets, even to the point of possibly investing in hospital campus-based health clubs.

The reality for all the panelists, though, and one they all acknowledged, was summarized perfectly by Loma Linda’s Zirklebach, who noted that “We’re in two lines of business at the same time—our sickness business line and our wellness business line.” What’s more, Zirklebach conceded, “It’s hard to get individual providers interested in this”—encouraging their patients forward in healthy behaviors and lifestyles, in addition to purely medical care-based attention—when the organization itself hasn’t yet committed fully to population health work.

And that’s where the leadership and policy issues come in. “We need payment model reform,” Landa said bluntly. “As long as we’re in a fee-for-service world, there’s not a lot of motivation to pursue population health seriously, until you go to a real accountable care model that involves at-risk payment or capitation, whatever you call it. We can’t fix certain things in medicine,” he added. “The very fact of a patient being on Medicaid is a risk factor for readmission for congestive heart failure. and other chronic diseases. Population health is a lot bigger than the question, which of my patients did or did not get a particular intervention? It’s supporting the health of a population. And payment models have to change to enable it.”

That having been said, Landa readily acknowledged that leadership with patient care organizations will help get the ball rolling. And here’s the thing about all this, something implicitly conceded by the panelists Wednesday morning: once leaders of healthcare organizations have shown personal leadership, they will have begun to drive the identification of vision, mission, and strategy, which will then inform IT strategy; and then technology implementation will naturally follow.

And, all the Wednesday morning panelists agreed, patient care organizations need to start somewhere when it comes to population health. All agreed that organizations should start small, celebrate gains, and build their initiatives organically, even as policy mandates and industry change are rapidly pushing healthcare providers towards the tipping point of having to move forward on population health.

And the stark reality is that the organizations in which population health and the new healthcare are on the front burner and moving ahead, are organizations in which individual leaders have seen the future and are forcefully helping to guide their colleagues towards that future. And that individual and group leadership is irreplaceable, particularly right now, as healthcare and healthcare IT leaders have so very much on their plates. Conversely, of course, it should come as no surprise that those organizations lacking such leadership are woefully behind in preparing strategically, operationally, and technologically, for the future. Because it is people who will lead in the adoption of tools, and, obviously, not vice versa.

So when people within healthcare IT talk about solutions, platforms, and tools, really—as was made clear Wednesday morning in San Francisco—they need to begin by first talking about policy and industry imperatives; and about vision, mission, and strategy; and they and their colleagues need to show leadership around a vision of the new healthcare that will inform their IT strategy, and then finally, their IT implementation. Because the tools are the servants, and the people are the leaders.

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