How to incorporate health information technology into national health objectives is a challenge for the Healthy People 2020 process. Looking back a decade, health IT was barely on the radar. These days, using the web for health information-seeking, improving healthcare outcomes and standardizing (and digitizing) health records is a large part of the healthcare policy conversation. In Health Affairs, three articles summarize and critique some of the work being done at the national level [Note: you may need a paid subscription to access the full articles]. Because Health IT in one way or another touches on the practices of social marketers who work in health, it is important to understand what the upstream discussion is all about. The outcomes will impact your life and the lives of the people you serve (and that goes for international readers in your own countries too).
The Director and Deputy Director of the Office of the National Coordinator for Health Information Technology at HHS are two of the authors for the piece that introduces the Strategic Framework and the Federal Health IT Strategic Plan released in June 2008 (links to the full reports).
The Strategic Plan has two goals: enabling high-quality and efficient patient focused health care; and supporting population health activities, including public health, biomedical research, quality improvement, and emergency preparedness. Under each goal, the plan identifies four focus areas: promoting adoption and use of health IT, establishing collaborative governance, ensuring the privacy and security of patients’ health information, and achieving information interoperability.
They review advances and achievements in encouraging the adoption and use of electronic health records, developing collective governance structures, creating privacy and security policy for health information and setting standards for interoperability among existing health IT standards so that a Nationwide Health Information Network (NHIN) will allow for the sharing of health information over the web.
In one of the companion articles, Carol Diamond and Clay Shirky from the Merkle Foundation write:
One of the biggest obstacles to expanding the use of information technology (IT) in health care may be, ironically, the current narrow focus on how to stimulate its adoption. IT is a tool, not a goal. Success should not be measured by the number of hospitals with computerized order entry systems or patients with electronic personal health records. Success is when clinical outcomes improve. Success is when everyone can learn which methods and treatments work, and which don't, in days instead of decades.
They note three barriers to the use of IT that transcend the technology itself:
The lack of either legal or financial incentives to share information across institutions.
Concerns among physicians and hospitals about how the technology will be financed.
- Consumer suspicions about how their data will be used and kept safe from misuse.
Their conclusion is: The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist "magical thinking," such as the notion that technology will transform our broken system, absent integrated work on policy or incentives.
David Kibbe & Curtis McLaughlin identify three ‘unmentionables’ that serve as a subtext for much of the work in Health IT policy to date. The first is that the work has had respond to expanding and changing public policy and political objectives. The need to adapt to changing missions and goals has not resulted in changes in organizational structures, technologies or players.
The second unmentionable relates to the nature of the health care IT markets: …we have neither a government-managed system nor an efficient market for health care, but often sets of local and national oligopolies wherein two or more dominant providers of services have enough market power to avoid price competition and compete instead on reputation, amenities, and broad and expanding scope of services. Health IT seems to follow that pattern. They cite social network analysis that demonstrates how key players have tended to dominate the entities established by the government to set the rules and standards. They point out how large players in other fields that have been extremely successful in crating a digital marketplace (financial services for one) have been effectively ‘locked out’ of health IT discussions, depriving the health initiatives of this knowledge and experience base to inform policy development.
The final unmentionable has to do with the explosion of internet-based alternatives to current ways of thinking about health IT. As regular readers of this blog know, the Web 2.0 has, as the authors phrased it, …leapfrogged over issues of health IT adoption by doctors and hospitals to tackle much broader - and ultimately important - issues such as how to use the Internet to track people’s health experiences, how to use the power of social networking to improve standards of treatment, and how to deliver medical advice over the Web. The authors note how current health IT policy efforts focus on vertical integration among existing health care institutions, while the consumer-driven focus of the leapers has been driven by the awareness of the public need for horizontal information transfer, often beyond the boundaries of traditional health care institutions and their dedicated networks. Yet even people who are aware of these developments do not incorporate them into the current discussions and plans.
Further conversation about these articles is happening at the Health Affairs blog that anyone can access.
The obvious question I get from this discussion is: can we afford to wait for a complete overhaul of the healthcare system before arriving at ‘sensible’ health IT goals and objectives? I think not. Rather than focusing on the wrong question, I suggest we consider:
- How do we facilitate the introduction of disruptive technologies that empower people to drive the healthcare reform process, rather than be pawns in it?
- How do we guard against introducing more ‘health information asymmetry’ into personal healthcare choices where access to it and understanding of it become the new social determinants of health status?
- How do we maximize the ability of all people to utilize information AND communication technologies that allow them to access trusted and reliable sources of health information for decision-making, take steps for themselves and their families that promote health and receive the social support they need to live healthier lives and move closer to the realization of their dreams?
More conversations about Healthy People are starting up at the Healthy People 2020 wiki.