Military or Civilian Sphere, the Healthcare IT Challenges Look Equally Systemic

March 31, 2015
It was an honor to chair the healthcare IT section of the World Health Care Congress last week, and within that section, to moderate a panel discussion that probed some of the common challenges facing both military and civilian U.S. healthcare

It was an honor and a privilege to be named Summit Chairman of the 12th Annual Health Information Technology Summit, the healthcare IT section of the World Health Care Congress, held March 22-25, at the Marriott Wardman Park Hotel in Washington, D.C. At the Health Information Technology Summit, so many healthcare IT leaders shared so many insights in the panel discussions and presentations, that it really did provide attendees with a very strong sense of where healthcare IT is headed these days, and what the deep challenges and broad opportunities are for our industry.

And I was privileged to be asked to moderate one of those several panels myself, held on March 23, under the heading, “Adopt Technology as an Engine for Health Care Advancement.” I was honored by the presence of my three co-panelists, David Bowen, CIO of the Military Health System, and director, health information technology, at the Directorate for the Defense Health Agency; Richard Skinner, chief information and technology officer at the University of Virginia Health System; and Manish Vipani, vice president, enterprise architecture, at Kaiser Permanente.

Not surprisingly, given that we had a mix of military and civilian healthcare IT leaders, we found ourselves engaged in quite a lot of discussion of the contrasts between the challenges facing the military and civilian healthcare systems when it comes to IT.

“We're in the process of creating a true system,” Bowen of the Military Health Care System said. “We're trying to get the services to do things the same, because they've run things in a stovepipe manner. Our budget for healthcare last year cracked 10 percent of the military's budget in toto, and that got a lot of attention,” he noted. “And,” he said, “I stood in front of our leadership, and asked, if we were a Fortune 500 company, how big would we be? And it turns out we'd be 53rd” largest Fortune 500 company. “And I asked, how would we be perceived by our board? And one of our senior leaders said, we'd all be fired, because we've run things in such a fragmented way. So I've been helping to lead a lot of business and cultural transformation,” he reported. “And we're implementing a system-wide EHR [electronic health record], which has gotten a lot of attention as well. I tell people I'm a cultural anthropologist.”

It was refreshing to hear such a level of candor from someone working within the military healthcare system; and rather validating in a certain way to hear that many of the core challenges facing military healthcare leaders are the same ones facing their civilian counterparts.

Indeed, when it comes to thinking about how the U.S. healthcare system must better serve the needs of its clinician end-users, whether civilian or military, the University of Virginia’s Skinner said that the biggest challenge facing him and his colleagues lately has been “how to put ourselves in the customers' place. You shadow a nurse on a inpatient unit and watch her trying to navigate all these complex systems,” he said, and it becomes clear how very unfriendly to end-user clinicians the clinical information systems they are compelled to use, really are. “So for us in the IT world,” Skinner said, what is very important “is seeing things through the customer's eyes, seeing how things look to the person actually using these [systems].”

Part of the solution, Kaiser’s Vipani noted, will be the coming of “the marriage of the internet of things into healthcare. Building a hospital in Dan Diego with smart lightbulbs, and with hand hygiene dispensers with sensors to document net individual use,” are examples of ways in which technology implementation will help to transform processes in healthcare. “I think the internet of things will fundamentally change health care,” he added.

The sentiment has sometimes been expressed in healthcare that it would be great to have all of a patient care organization’s clinicians be salaried staffers, as is true in the U.S. military, as well as in a number of foreign healthcare systems. Yet the reality is that the armed forces already have that advantage, and yet continue to struggle to overcome siloing and communication gaps, as the Military Health Care System’s Bowen noted.

Still, Bowen and his colleagues are moving with alacrity to break down the silos and evolve the military healthcare system forward towards greater integration and customer-friendliness (whether the customers be clinicians or patients). As he noted, “We’re looking at six areas of the country where we’ve got multiple facilities for multiple services in the same communities, and are finding how we can best serve patients. We might send an Army soldier to an Air Force facility, for example,” or shift individual facilities from serving only one branch of the armed forces to serving military personnel from all branches. “As we move forward,” he said, “we’re focusing on the whole idea of systemness, and doing what’s best for everyone in the system.”

So, as we all move forward in U.S. healthcare, it will continue to be very important, and extremely helpful, to have discussions like the one we held last week in Washington, D.C., in which leaders from every sector within U.S. healthcare share with other leaders from other sectors, how we can all best move forward. Because when it comes down to it, most of the fundamental challenges we face are present across healthcare industry sectors. And when we discuss the issues at a strategic level, as we did last week, the potential for strategically driven change that can fundamentally transform U.S. healthcare, can only become more and more possible and likely going forward.

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