Earlier this month I was on a business trip in Europe. I met with healthcare leaders in the UK, Sweden and Holland. In the UK, there was a lot of discussion about the ramifications of the decision to decentralize budgeting for the National Health Service (NHS). Essentially, each of the various NHS trusts is now in charge of their own budget and budget planning. General Practitioners are front and center in determining how the budgets are allocated and spent. This puts considerable decision-making power in the hands of primary care physicians. For instance, they are now deciding how money gets spent on Health IT projects in the UK. Actually I think that makes a lot of sense. Without “ownership” by the people who are most affected, Health IT projects that touch clinical workflow frequently fail.
Last week, a little closer to home, I was pleased to see another example of primary care docs actively engaged in Health IT decision making. On Friday I provided a keynote address at the annual Learning Forum for OCHIN in Portland, Oregon. This not-for-profit organization supports providers and practices working to select, install, and effectively use health IT to achieve clinical, operational, and financial improvements. OCHIN provides Health IT, data aggregation and exchange, quality improvement, and research services to support providers and practices working to realize Triple Aim goals (higher care quality, better access, lower costs). The organization operates in 17 states.
The evening before my keynote, I was invited to address the OCHIN board of directors at their annual business planning meeting. I was pleased to see so many primary care docs around the table. We had a lively discussion about the future of Health IT and the future direction of OCHIN itself. As I reminded the board, selecting and implementing EMR solutions is just the beginning of the Health IT journey for any practice, clinic, or hospital. The real power of Health IT in transforming healthcare (and realizing the Triple Aim) comes from what you do with digital health information once you have it. The EMR isn’t an end in itself, but rather a foundation that opens up possibilities to measure what we do within healthcare practices and organizations and compare it to best practices across the country and around the world.
Too often these days I see decisions being made about healthcare and healthcare delivery by everyone but physicians. It’s often stated that doctors are just too busy managing their own patients and practices to take on much of an active role in clinical IT projects, health information exchanges, business and clinical analytics, or new payment models. While understandable, not being at the table is a serious risk for clinicians as the decisions that are being made will have long lasting ramifications on the practice of medicine and their own futures. I guess that’s something that isn’t lost on the physicians and other clinicians who so generously give their time to serve as board members of OCHIN.
As we prepare for the Thanksgiving Holiday, let’s all be thankful for what we have. Let’s also remember that what we have today is often because of the hard work and sacrifices of those who came before us (parents, soldiers, teachers, mentors, leaders), and because of our own determination to roll up our sleeves, step up to the table, and do the hard work that moves us forward.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Hi, I'm from the UK and was interested to see your summary of how our dear old NHS is moving forward. The problem though with IT in the NHS is that people move around the UK and the records are not transferable - there are lots of issues with confidentiality and the reason that responsibility has been passed back to Doctors is that we have already spent millions of pounds in developing a national IT system which has had to be abandoned because it was 'too hard' to do. Our local GP's have no experience of being able to deliver anything like this on a regional scale (its all a new model); I'm not really sure that having individual Doctors responsible for each district is going to be in the patients interests long term.
Thanks for writing. I agree that these are complex projects. Clinicians alone can't do it, nor can large organizations or even government do it alone. However, clinicians need to be at the table working in partnership with organizations and government if we are to succeed in transforming the delivery of health and healthcare using technology to its best advantage.
Bill Crounse, MD
Hi. Dr. Crounse. I'm an OCHIN board member, unable to attend the OCHIN meeting due to my own board meeting. Thanks very much for your comments regarding the OCHIN approach. Preserving OCHIN's unique approach to HIT decision-making has not always been easy. Thanks for the validation.
Sorry I missed you at the meeting. There's nothing easy about any of this, but not having physicians at the table is a non-starter for me. Keep up the good work.