Information technology’s benefits come at a price
By Joe Flower
From Healthcare's Most Wired 11/28/05
Gathering and accelerating trends across health care pose at least 16
distinct information technology challenges. Some will be slow to build,
while others will be more sudden; some will be drastic, and others more
subtle. But all will have to be met and overcome in the next five to 10
years.
Five
factors will make the need for better communications, better data
collection and better metrics vivid in the minds of the public, major
industry players and policy-makers: The advent of personal genomics
will create a whole new category of privileged information that will
need to be stored, handled, distributed and protected (1).
The major pandemics that epidemiologists expect will throw into sharp
relief the fragmented and anemic nature of our health care
communications (2).
The
sheer cost of health care, augmented by the rise of consumer-directed
health plans (CDHPs), will make the consumer’s voice ever more powerful
in health care. This, in turn, will bring an ever-sharper demand for
transparency and greater clinical quality, which will require ever more
computerized, automatic and ubiquitous metrics (3).
At the same time, the rise of CDHPs will lead to major and direct
involvement of the financial services industry in health care, which
will further increase the demand for metrics, documentation and a
continuous flow of financial information (4).
In
reaction to demands for lower costs and higher quality, the spread of
the Toyota Production System and similarly lean models will further
increase the need for metrics on everything from inventory and space
allocations to waiting, turnaround and transport times; in other words,
every operational detail (5).
In
four feedback loops, the use of IT itself will create a need for
greater use of new technology. The decentralization that IT allows will
exponentially increase the necessity of these systems (6).
The greater transparency allowed by metrics will steadily increase the
demand for greater clinical quality, which will in turn call for more
metrics, more accountability in the software, and more information
available at the point of care (7).
Meanwhile,
advances in robotics and automation in areas as disparate as surgery,
housekeeping, message delivery, pharmacy and laboratory will demand
greater communications between these systems (8). Personal
nanodiagnostics (think Star Trek-style medical Tri-Corders) and other
home-based health IT will create a demand for communications between
the customers’ technology and that of the providers (9).
Two
large-scale factors – the aging of the baby boom generation and the
advent of the peak of the global oil-production arc – will tend to
accelerate health care inflation (10, 11). This will
further exacerbate the ferocious demand for greater efficiencies in
which IT plays a central role by creating better metrics, enhancing
communications and reducing transaction costs.
In
the face of all these rising demands, four factors beyond general
health care inflation will seriously constrict the availability of both
capital and operating funds for IT expansion. A move toward
pharmaceutical interventions, especially in the fields of
cardiovascular care and oncology, will greatly reduce some of the major
revenue sources of hospitals (12).
U.S.-based
insurers will incorporate overseas outsourcing of many major
schedulable operations into their cost-cutting efforts, further
attenuating U.S. hospitals’ revenue streams (13). And
hospitals will face ever-increasing competition from privately owned
specialty providers, which will sharpen the need to hold down costs and
cause some hospital executives to cut IT funds, even though the
technology, wisely deployed, could hold the answer to cost reduction (14).
Rates
in the long-term debt market will rise, making capital harder to secure
for not-for-profits as East Asian economies cease pouring their excess
dollars back into U.S. instruments and peg their economies instead to
"floating baskets" of global currencies (15).
Finally,
the pace of change is creating a powerful need for knowledge
management, sense-making and competency transfer structures within
organizations and across professions, systems and communities of
practice. Much of this information, of course, must be mediated through
new information technologies (16).