The Promises and Perils of America's Healthcare Development

David Kaelber, CMIO, MetroHealth

David Kaelber, CMIO, MetroHealth

Healthcare is starting to go to the digital transformation that many other industries have already wandered on. The decade from 2010 to 2020 would be the decade of adoption. If you look at all the data, the electronic health record adoption has really skyrocketed over the last decade. We are still at the crust of the waves, in the sense that it is coming towards the technology—the disruption in transformation of healthcare. Services at a macro level are happening in lots of institutions. To cite an example, MetroHealth has had its own electronic health product since 1999 and we passed major implementation trying to figure out where does the electronic health record really has value to the healthcare system and annotation that we take care of.

The analogy that we use to apprehend this—the electronic health record is to the paper record as the power nail-gun is to the manu/al hammer. Imagine you’re used to building a house with the hammer and somebody gives a power nail-gun. Even though it will cost a little more than the hammer, the end result would be much more cost effective, faster, presumably of even higher quality. That’s a reasonable analogy if all you are trying to do is implement it. And now, our healthcare systems realize the investment needs to be done in terms of training, support and re-envisioning a healthcare system.

One of the most important things is, the healthcare industry has been more focused on data. From slashing healthcare spending to detecting fraud or coordinating cure across multiple providers, improved use of healthcare data has been held up as a “silver bullet” to slay all kinds of healthcare “monster.” The data related to any industry used to be trapped, in paper or somewhere else. Now since it is digitized, once you have access to digital data, you potentially can do amazing things with it. Healthcare is a very data-rich environment. And nothing will happen just because of the data—you need to get the tools, the people and the processes that are fuelled to actually change something important in healthcare systems. You are doing something with the data to improve value that actually increase revenue somehow or decrease the expenses.

Although, I don’t think it’s a silver bullet here, but it can help. When you have an integrated personal health record with your electronic health record, you can send alerts and reminders and engage the patients in their own health care. Particularly in pay-per-performance program where the standard is not necessarily an absolute standard, where we are not trying to get to a 100 percent. But we are compared with how peer institutions are doing. The fact that you might be able to jump off 20-30 percent better than your peer institutions can be significantly of value.

"One of the most important things is, the healthcare industry has been more focused on data"

In addition, the role of a Chief Medical Officer (CMO) is very important. In the healthcare system there were clinical people and IT people—the two never needed to interface with each other. This is because, usually the technical people were more focused on making sure the internet works, or the clinical systems that healthcare employees or physicians use on regular basis.

Now, the analogy that uses the clinical information systems is becoming the nervous system of the healthcare. In that model you really need the CMO. And the informatics team too, at some level, act as the brain for that system, to make sure things are being coordinated in the appropriate way. A lot of times the language and the culture that technical people grow up into are not synergistic to that of the clinical people. So the role of the CMO, as the leader, helps to bridge that gap—the mutual benefit of each group and the overall added value to the healthcare systems. In fact if you are in a healthcare system that doesn’t have a CMO, you are not going to survive.

And more than just a CMO, you need a CMO with informatics scheme. That’s critical in getting valuable health information and even making informative decisions.

We’re using the analogy of the heart and cardiologists. If you’re a patient, every patient should know if the doctors tell them that it’s something about the heart. If you’re going to a regular doctor, they just need to know little bit about the heart—enough to know if the patient needs more help. And then for certain patients and certain situations, they need a cardiologist and some patients might need lacto-physiologists or even a cardiology sub-specialist. The same thing can be said for health information technology or informatics. Every physician, nurse, pharmacist, therapist, or anyone using health information technology needs to know something about informatics. It might be at a pretty superficial level for most of those folks. We also need a subset of those folks who’d take it to the next level. Now there’s a board certifying clinical specialty or clinical informatics. We need some position to provide rigorous training with a board that certifies in clinical informatics. In future, performing healthcare systems is really going to need people from all of those realms—everybody having some basic knowledge, some having deeper knowledge and people who are certified in clinical informatics.

I think the future is very bright. If you look at the digital revolution in other industries, after the revolution it’s totally night and day. That’s the way it should be for healthcare too. It’s very hard to anticipate how much of it will be transformed in a 20 year time frame. Where people see the transformation happening right now, I’m not sure if that’s where transformation is going to be 30 years from now because a lot of these transformations are relatively immature and a lot of technologies have a long way to go. It’s difficult to know what the killer act will be in a decade from now. But it’s going to be amazing for patients, physicians, employees or the general health of our country. I think healthcare really has the potential to transform all of that for good. But it’s more than technology; we have to have the ideologies in place and then we have to go beyond that if we realize that the value for our country.