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Dr. William Stead, MD
Associate Vice Chancellor
for Health Affairs & Director
Informatics Center
Assistant to the Chancellor
for Informatics
Chairman, Vanderbilt Center
for Better Health
 The goal of the VCBH is to create
a focus that accelerates the industry's
transformation to better healthcare.
The Center’s Role
Transformation through technology requires unprecedented focus and cooperation
among multiple
constituencies and disciplines.
Serving as a catalyst for transformation, VCBH will engage in the following
activities:
1) Create a neutral playing ground
where different parties can come
together
to set an agenda and
roadmaps for measurable change.
2) Conduct basic research and provide
test beds to develop, prototype and
refine people, process and technology solutions.
3) Make proven methodologies
available to every organization
so that people
do not need to learn
on their own.
4) Provide a consulting model that
works... that helps organizations
decrease
the time and energy
required to make changes.
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To the VCBH, transformation is change that results in greater than 40%
improvement over previous outcomes. We believe that transformation is
possible through the synergy of informatics and the redesign of healthcare
delivery systems. This synergy can reduce variability and costs, resulting
in better outcomes and increased efficiency.
Transformation requires a complete shift in the way information is used
and care is delivered. Beginning with medical education, clinicians must
develop the skills to make decisions based on information presented to
them. Process and technology must provide easy access to information when
and where it is needed. Traditional roles must change such that patients
become active participants in their own care by utilizing information
from their physician who serves as their mentor or coach. Reimbursement
systems need to provide the right incentives for everyone.
Inefficiencies in the healthcare system due to variation, unnecessary
activities, and other factors severely impact patient care and lead to
$260 billion of waste each year.
The Institute of Medicine (IOM) report, "Crossing the Quality Chasm: A New Health System for
the 21st Century", explicitly calls for fundamental changes in
the way healthcare is organized and the environment in which it is practiced.
It assumes a robust information technology infrastructure. Translating
this vision into action requires discontinuous change on multiple fronts.
Challenges to IT in Healthcare
Although the Institute of Medicine (IOM) Committee on the Quality of Health
Care in America paints a compelling vision of the dramatic improvement
possible through a systematic approach to healthcare, it does not address
how the requisite information management infrastructure is to be provided
or adopted.
Providers need decreased time associated with administration; more
time for patient care; access any time or place to on-line lab results,
electronic prescribing, electronic medical records, etc.; and real-time
integration of evidence and patient data into the care process.
Payers/employers expect on-line claims, enrollment, referral, payment
administration; personalized benefit design and consumer self-service;
and advanced, web-based disease management programs.
Consumers/patients demand access to leading-edge healthcare information
and education programs; personalized, web-based health management programs;
and improved communication with their personal physician and other experts.
Pharmaceutical companies want improved communication with physicians
(e-detailing) and consumers; faster identification of clinical trial candidates/improved
trial administration; and market identification for designer products
(pharmacogenomics).
As with most industries, the internet promised to positively impact the
entire healthcare value chain. To date, the internet and more specifically
the e-health industry has been unable to deliver on its promises.
Relative under use of information technology in the healthcare industry
is widely recognized. The problem goes beyond resistance to investment
by the industry and resistance to use by practitioners. The reality is
that many investments in information technology by the healthcare industry
have not met the expectations. Seldom do these investments reflect the
key lesson that success comes from figuring out fundamentally different
interactions between people, process and technology.
Barriers that hamper growth of healthcare IT are complex and interconnected.
Technology Barriers — Interfacing with legacy systems; bandwidth;
latency; security; complexity of data due to biologic variability
Regulatory/Policy Barriers — Lack of data standards; data security/patient
privacy regulations; Federal/state laws (e.g. licensure issues)
Market Barriers — Fragmentation of end-user market; continuation
of bad or no data creation; overwhelming amount of new e-health product
(“Buyer Blurr”)
Financial Barriers — Shrinking operating margins in healthcare;
separation of user/purchaser of care; reimbursement slow to reflect new
e-roles and IT infrastructure needs
Cultural Barriers — Physicians slow to adopt new technology; fear
of change; poor communication among healthcare constituencies
Organizational Barriers — Protect the status quo; policy/procedure
vacuum (no benchmarks); lack of appropriate internal communication; lack
of resources to support change
An effort to redesign the healthcare system through incremental change
is unlikely to succeed. Introduction of information technology on top
of an old system is ineffective because it adds supplemental cost and
effort with minimal return.
Making it happen: discontinuous change
An effort to redesign the healthcare system is unlikely to succeed through
incremental change. Introducing information technology on top of old ways
of working adds supplemental cost and effort with minimal return. Various
players may appreciate the overall purpose, but continuing to be effective
and profitable individually through the change is difficult.
Figuring out fundamentally different interactions among people, process
and technology will result in new ways of working that provide a step
function improvement in quality, cost or market size. It is almost impossible
to figure out the new ways of working without using the technology, and
equally difficult to design the technology infrastructure without insight
into how it will be used.
Since such new ways of working are impossible without the technology,
the change is discontinuous.
Transformation can occur through the synergy of technological
advances and redesign of healthcare deliver.
Regardless of our ability to solve historic problems, the rate of advancement
toward personalized medicine continues to accelerate. HIPAA, Internet2,
molecular diagnostics, consumerism, Next Generation Internet (NGI) and
genomics are rapidly moving us into the "future state" of healthcare.
Placing these advances in our current system will not bring about transformative
change. It will take reengineering of our technology infrastructure
while redesigning healthcare delivery systems to deliver on the potential
of technological advance.
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