HIT for Righter or Wronger

It too often seems, that promises and pitfalls notwithstanding, the way in which most people think about Health Information Technology (HIT) is as if they had a solution in need of a problem. HIT increasingly is promoted as the answer to what ails healthcare, but many have only general or vague notions of exactly what can be fixed by HIT or perhaps more importantly, how HIT would actually fix these problems. In my view, we have a people problem, not a technology problem. As noted by Harvard health economist David Cutler, one way to think about healthcare reform is to think about it in terms of 1) getting providers to do the right thing and 2) getting patients to do the right thing. Despite being a sweeping generalization and gross oversimplification, there is indeed some truth to this characterization of the health problem in the US. That said, solutions to a people (providers and/or patients) problem reside ultimately with people. Unless people (providers and patients) consistently do the rights things we will likely continue to have health and healthcare challenges. If, for example, in our rush to embrace technology, all we do is change the current paper based medical records to electronic medical records, we will still have the problem of missed clinical opportunities, misdiagnoses, inappropriate medication interactions because those providers who do not currently read the paper based medical records, will also not access the electronic medical records or they will access them to look for the same information they now look for and use that information in the same way they now use it. Thus this new technology, after much time, angst and money will likely result in exactly the same outcomes. If HIT is to achieve its promise and potential it must enable and or encourage people (providers AND patients) to do differently those things that need to be done differently, not just help people do things faster or help them to do the wrong things, well… wronger. This is why some are now beginning to use the term Health Improvement Technology (HiT). HiT refers to next generation HIT and technology innovations that improve  health and outcomes by delivering coordinated and seamless interactions across location and devices. The idea grows from a premise that we must first understand the fundamental problems then seek to understand if technology opportunities exist to address the identified problems wherever they exist, whether the problem is with providers or patients, in the hospital or in the home or community. If so, move forward. If not, stop. It builds on leadership that is unafraid to critically look at what we (providers, patients and policy makers) are doing in the context of what we should be doing to create health value (to providers AND to patients) without allowing distractions of reimbursement, infrastructure, organizational culture or protectionism to get in the way. What are the fundamental problems? What do we need to do to fix the problems for everyone involved? How do we make it happen? Period! Sounds like a strategy to eliminate healthcare disparities, reform healthcare and most importantly, improve the health of our nation.