I was recently asked to predict IT Winners and Losers in 2009.
Rather than name individual companies, I'd like to highlight categories.
Winners
1. Electronic Health Record vendors, especially web-based applications - The Obama administration has promised $50 billion for interoperable EHRs.
2. Software as a Service providers - SaaS providers offer lower cost of ownership and faster implementation than traditional software installation approaches.
3. Open Source - I'm embracing Open source operating systems, databases, and applications as long as they can provide the reliability and supportability that I need.
4. Green IT - Winners will be innovative techniques to adjust power draw, such as idle drive management, cpu voltage adjustments, and high efficiency power supplies.
5. Cloud Computing offerings - These are remote infrastructure utilities such as storage and high performance computing. Friday's Cool Technology of the Week will describe a new technology called Cloud Optimized Storage.
Losers
1. Client Server applications - the cost of deploying, supporting, and maintaining client server applications is no longer affordable.
2. Proprietary operating systems - I'm eliminating Solaris, AIX, HP-UX from my data centers.
3. High end SAN storage - I find that 90% of my storage needs are met with lower end SAN, NAS, and appliances which use low cost, high density drives (SAS and SATA).
4. Devices that do not offer energy efficient operations.
5. Applications that require a specific operating system or a specific browser on the client side. To be successful in 2009, applications should be operating system neutral, browser neutral, and easily hosted as a service accessible via the web.
I welcome your thoughts on your own winners and losers for 2009.
Selasa, 11 November 2008
Senin, 10 November 2008
The Impact of the Economy on Healthcare IT Spending
I was recently asked to comment on the impact of the struggling economy on my IT spending.
In all my organizations, I have two kinds of budgets - capital and operating.
Capital is used to purchase durable equipment and to fund project implementations. We often capitalize the labor, consulting, and license costs incurred when acquiring and installing a product.
Capital in my organizations is based on the following equation:
Available capital spending = Operating Margin + Investment Performance + Donations + Depreciation - Debt Service
In today's economy, spending on elective surgical procedures is going down, energy costs are rising, and reimbursement is falling - all putting pressure on operating margin.
Investment performance for many organizations, especially those which invested in mortgage backed securities, is causing loss of principal. Luckily my organizations had invested conservatively.
Donations are more challenging when consumer confidence is low.
The end result is that 2009 will be a challenging capital year because of lower operating margins and investment performance. We will have enough to keep the trains running on time, to ensure our disaster recovery efforts continue, and to remain compliant with all our regulatory requirements. However, we will extend the timelines of some projects to conserve capital.
Operating budgets are used to fund salaries, maintenance contracts and supplies.
For now, operating budgets are stable, but the outlook is conservative. Adding new positions is challenging and we are managing all our contracts carefully. We're negotiating hard and thinking creatively about how to trim operating expenses by reducing the complexity of our hardware and software environment.
All projects are function of Scope, Time and Resources, so tight operating budgets mean fewer resources which means narrower scope and longer time for our projects.
All this being said, I believe that economic challenges are good for IT organizations because it forces customers to prioritize their projects, matching their demand to limited IT resource supplies.
In summary, we are limiting major capital purchases, extending timelines, and focusing on the highest priority projects. We are not expecting major new enterprise purchases, instead we will refine and improve what we have.
One last thought. In the spirit of buy low, sell high - the best time to purchase is when demand and prices are at a low point. We will keep looking for bargains that will reduce our capital and operating costs over the long term. Eventually, the economy will improve and we want to be in the best position when that occurs.
In all my organizations, I have two kinds of budgets - capital and operating.
Capital is used to purchase durable equipment and to fund project implementations. We often capitalize the labor, consulting, and license costs incurred when acquiring and installing a product.
Capital in my organizations is based on the following equation:
Available capital spending = Operating Margin + Investment Performance + Donations + Depreciation - Debt Service
In today's economy, spending on elective surgical procedures is going down, energy costs are rising, and reimbursement is falling - all putting pressure on operating margin.
Investment performance for many organizations, especially those which invested in mortgage backed securities, is causing loss of principal. Luckily my organizations had invested conservatively.
Donations are more challenging when consumer confidence is low.
The end result is that 2009 will be a challenging capital year because of lower operating margins and investment performance. We will have enough to keep the trains running on time, to ensure our disaster recovery efforts continue, and to remain compliant with all our regulatory requirements. However, we will extend the timelines of some projects to conserve capital.
Operating budgets are used to fund salaries, maintenance contracts and supplies.
For now, operating budgets are stable, but the outlook is conservative. Adding new positions is challenging and we are managing all our contracts carefully. We're negotiating hard and thinking creatively about how to trim operating expenses by reducing the complexity of our hardware and software environment.
All projects are function of Scope, Time and Resources, so tight operating budgets mean fewer resources which means narrower scope and longer time for our projects.
All this being said, I believe that economic challenges are good for IT organizations because it forces customers to prioritize their projects, matching their demand to limited IT resource supplies.
In summary, we are limiting major capital purchases, extending timelines, and focusing on the highest priority projects. We are not expecting major new enterprise purchases, instead we will refine and improve what we have.
One last thought. In the spirit of buy low, sell high - the best time to purchase is when demand and prices are at a low point. We will keep looking for bargains that will reduce our capital and operating costs over the long term. Eventually, the economy will improve and we want to be in the best position when that occurs.
Jumat, 07 November 2008
Cool Technology of the Week
There is a technology that I've used for several years that has been so successful, it merits discussion as a Cool Technology of the Week.
Getting data into an electronic health record is hard. Most clinicians do not want to type complex structured notes. We've tried macros and templates, which have helped some. However, dictation is the clear winner among clinicians for entry of free text.
The challenges with dictation are turn around time, expense, and lack of structure. BIDMC's solution to this problem as been server-based voice recognition from eScription.
Here's how it works:
* A clinician dictates into a phone or handheld
* The voice file is sent to the voice recognition server where we store the voice profiles of 3000 clinicians
* In near real time, the voice files are processed into text and inserted into the electronic health record as an unsigned note
* Correctionists (we no longer use transcriptionists) review the notes for accuracy. We achieve over 90% accuracy across all speakers and all note types
* Clinicians sign their corrected notes.
By using server-based voice recognition, we have reduced our transcriptions costs more then 50%, reduced turn around time to less than an hour, and used the technology to increase the structure of our free text notes. How?
When clinicians dictate operating room notes, history and physicals, outpatient notes, or radiology reports, they tend to dictate in their own preferred order, not via a universal template. Some clinicians may dictate chief complaint, history of present illness, physical exam, review of systems, assessment/plan. Others have completely different approaches. However, using voice recognition, we can recognize a key phrase like "physical exam" and automatically place it in a template. We've been able to increase the structure of our notes by 30% using voice recognition of subject headings.
Our total cost of implementation was about $500,000 and our savings over just the last year was over $1.5 million.
Happy clinicians, more structured notes, better turn around time and $5 million in savings since we implemented the technology. Now that's cool.
Getting data into an electronic health record is hard. Most clinicians do not want to type complex structured notes. We've tried macros and templates, which have helped some. However, dictation is the clear winner among clinicians for entry of free text.
The challenges with dictation are turn around time, expense, and lack of structure. BIDMC's solution to this problem as been server-based voice recognition from eScription.
Here's how it works:
* A clinician dictates into a phone or handheld
* The voice file is sent to the voice recognition server where we store the voice profiles of 3000 clinicians
* In near real time, the voice files are processed into text and inserted into the electronic health record as an unsigned note
* Correctionists (we no longer use transcriptionists) review the notes for accuracy. We achieve over 90% accuracy across all speakers and all note types
* Clinicians sign their corrected notes.
By using server-based voice recognition, we have reduced our transcriptions costs more then 50%, reduced turn around time to less than an hour, and used the technology to increase the structure of our free text notes. How?
When clinicians dictate operating room notes, history and physicals, outpatient notes, or radiology reports, they tend to dictate in their own preferred order, not via a universal template. Some clinicians may dictate chief complaint, history of present illness, physical exam, review of systems, assessment/plan. Others have completely different approaches. However, using voice recognition, we can recognize a key phrase like "physical exam" and automatically place it in a template. We've been able to increase the structure of our notes by 30% using voice recognition of subject headings.
Our total cost of implementation was about $500,000 and our savings over just the last year was over $1.5 million.
Happy clinicians, more structured notes, better turn around time and $5 million in savings since we implemented the technology. Now that's cool.
Kamis, 06 November 2008
Chocolate
Many people ask me if my vegan diet leads to continuous cravings for a Big Mac or a nice chunk of cheddar. I can honestly say that my diet of legumes, fresh fruits/vegetables, tofu, rice and green tea keeps me completely satisfied.
There is one other aspect of my diet that I've not discussed before - a little vegan chocolate every day.
Most chocolate contains milk products but a few producers make pure, dark chocolate that is 85% pure cocoa and does not contain any animal products such as milk or cream. My favorite vegan chocolates are
Lindt 85% Dark
Lake Champlain Dark Chocolate
Valrhona Dark Bitter Chocolate
Endangered Species Dark Chocolate
I have also found pure, unsweetened vegan drinking chocolate from single regions such as Peru, Kenya etc. packaged by Allegro
What are the benefits of Dark chocolate? It's rich in antioxidants, it lowers blood pressure, and it enhanced mood per WebMD and Dr. Weil's resources.
What is the downside to chocolate? It contains a bit of theobromine, a methylxanthine like caffeine. I try to avoid all stimulants. Chocolate is not for the locavore. I really try to limit all my foods to 100 miles of where I live.
Admittedly, eating .5 ounce of chocolate a day is vegan but not local, is healthy, but is still a stimulant. My only excuse is that I live in the cold, dark, and snowy Northeast. That little bit of chocolate every day is my cure for Seasonal Affective Disorder. It can also be socially responsible.
A few days ago while traveling, I ordered a microbrewed beer and was asked for my ID. Since I'm nearly 50 and was asked for my ID, I can only assume that those antioxidants in the chocolate must be really keeping me young.
There is one other aspect of my diet that I've not discussed before - a little vegan chocolate every day.
Most chocolate contains milk products but a few producers make pure, dark chocolate that is 85% pure cocoa and does not contain any animal products such as milk or cream. My favorite vegan chocolates are
Lindt 85% Dark
Lake Champlain Dark Chocolate
Valrhona Dark Bitter Chocolate
Endangered Species Dark Chocolate
I have also found pure, unsweetened vegan drinking chocolate from single regions such as Peru, Kenya etc. packaged by Allegro
What are the benefits of Dark chocolate? It's rich in antioxidants, it lowers blood pressure, and it enhanced mood per WebMD and Dr. Weil's resources.
What is the downside to chocolate? It contains a bit of theobromine, a methylxanthine like caffeine. I try to avoid all stimulants. Chocolate is not for the locavore. I really try to limit all my foods to 100 miles of where I live.
Admittedly, eating .5 ounce of chocolate a day is vegan but not local, is healthy, but is still a stimulant. My only excuse is that I live in the cold, dark, and snowy Northeast. That little bit of chocolate every day is my cure for Seasonal Affective Disorder. It can also be socially responsible.
A few days ago while traveling, I ordered a microbrewed beer and was asked for my ID. Since I'm nearly 50 and was asked for my ID, I can only assume that those antioxidants in the chocolate must be really keeping me young.
Rabu, 05 November 2008
Healthcare IT in the Early Obama Administration
When Obama takes office in January, the economy will be his first priority, followed by the war in Iraq. Healthcare will follow as his next major issue to address.
What will he do?
I imagine he'll take a phased approach to ensuring all Americans have access to healthcare. Given the change management needed to accomplish this, it will take a while.
However, Healthcare Information Technology has broad bipartisan support and is his best strategy to reduce healthcare costs, reimburse providers for quality instead of quantity, and to ensure coordination of care. Here are my predictions for healthcare IT in the first year of the Obama administration:
The AHIC Successor, with its board of 15 savvy operational people and 3 incorporators (John Tooker, John Glaser and Jonathan Perlin) will serve as the public/private collaboration for prioritization of healthcare IT initiatives during the first year of the Obama administration and likely beyond.
The Office of the National Coordinator (Rob Kolodner) will continue to coordinate Federal input into the public-private effort.
The Health Information Technology Standards Panel (HITSP) will continue to harmonize standards. Its work in 2009 will include
One new use case to harmonize the electronic standards needed to exchange data about newborn screening for treatable genetic, endocrinologic, metabolic and hematologic diseases. http://en.wikipedia.org/wiki/Newborn_screening
Closing gaps in standards for
General Laboratory Orders
Medication Management
Advanced Device Interfacing
Clinical Notes
Order sets
Scheduling
Secure Data Transport for all clinical data
Consumer Preferences for care
Clinical Registries
Maternal/Child Health
Long Term Care Assessments
Prior Authorization for testing
Consumer Adverse Event Reporting
Additionally, HITSP has the AHIC Successor's endorsement to work on standards for Clinical Trials and Research in collaboration with CDISC and other stakeholders.
The Health Information Security and Privacy Collaboration (HISPC) working groups will continue to inventory and harmonize privacy standards for states and territories
Hopefully the Obama team will offer incentives to implement EHRs early in the administration, but in the meantime hospitals will subsidize 85% of EHR implementation costs via Stark safe harbors and private payers will offer pay for performance incentives for the outcomes resulting from the use of EHRs and e-Prescribing.
States such as New York, Massachusetts, Tennessee, Indiana and Utah will continue to implement regional data exchanges that meet the needs of their local stakeholders.
The Certification Commission for Healthcare Information Technology will continue to develop functional criteria for EHRs, PHRs and Health Information Exchanges. HITSP harmonized standards will be included in CCHIT criteria and incorporated into EHRs in an incremental way over the next few years.
Thus ONC, the AHIC Successor, CCHIT, HITSP and HISPC will continue their work for the next year. My personal leadership role of HITSP continues until October 2009, crossing between administrations.
After the year it takes to stand up a new administration, we may see additional resources for healthcare IT, a new federally regulated exchange where Americans not covered at work would be able to choose among a variety of private group policies and a new public program to compete with the private insurers. New public and private IT initiatives will be needed to support the workflow of these new programs.
Next week, I'll be in Washington for AMIA, the last meeting of the AHIC, and an FDA meeting. I'll report on how the transition teams are beginning their work and the implication for healthcare IT.
What will he do?
I imagine he'll take a phased approach to ensuring all Americans have access to healthcare. Given the change management needed to accomplish this, it will take a while.
However, Healthcare Information Technology has broad bipartisan support and is his best strategy to reduce healthcare costs, reimburse providers for quality instead of quantity, and to ensure coordination of care. Here are my predictions for healthcare IT in the first year of the Obama administration:
The AHIC Successor, with its board of 15 savvy operational people and 3 incorporators (John Tooker, John Glaser and Jonathan Perlin) will serve as the public/private collaboration for prioritization of healthcare IT initiatives during the first year of the Obama administration and likely beyond.
The Office of the National Coordinator (Rob Kolodner) will continue to coordinate Federal input into the public-private effort.
The Health Information Technology Standards Panel (HITSP) will continue to harmonize standards. Its work in 2009 will include
One new use case to harmonize the electronic standards needed to exchange data about newborn screening for treatable genetic, endocrinologic, metabolic and hematologic diseases. http://en.wikipedia.org/wiki/Newborn_screening
Closing gaps in standards for
General Laboratory Orders
Medication Management
Advanced Device Interfacing
Clinical Notes
Order sets
Scheduling
Secure Data Transport for all clinical data
Consumer Preferences for care
Clinical Registries
Maternal/Child Health
Long Term Care Assessments
Prior Authorization for testing
Consumer Adverse Event Reporting
Additionally, HITSP has the AHIC Successor's endorsement to work on standards for Clinical Trials and Research in collaboration with CDISC and other stakeholders.
The Health Information Security and Privacy Collaboration (HISPC) working groups will continue to inventory and harmonize privacy standards for states and territories
Hopefully the Obama team will offer incentives to implement EHRs early in the administration, but in the meantime hospitals will subsidize 85% of EHR implementation costs via Stark safe harbors and private payers will offer pay for performance incentives for the outcomes resulting from the use of EHRs and e-Prescribing.
States such as New York, Massachusetts, Tennessee, Indiana and Utah will continue to implement regional data exchanges that meet the needs of their local stakeholders.
The Certification Commission for Healthcare Information Technology will continue to develop functional criteria for EHRs, PHRs and Health Information Exchanges. HITSP harmonized standards will be included in CCHIT criteria and incorporated into EHRs in an incremental way over the next few years.
Thus ONC, the AHIC Successor, CCHIT, HITSP and HISPC will continue their work for the next year. My personal leadership role of HITSP continues until October 2009, crossing between administrations.
After the year it takes to stand up a new administration, we may see additional resources for healthcare IT, a new federally regulated exchange where Americans not covered at work would be able to choose among a variety of private group policies and a new public program to compete with the private insurers. New public and private IT initiatives will be needed to support the workflow of these new programs.
Next week, I'll be in Washington for AMIA, the last meeting of the AHIC, and an FDA meeting. I'll report on how the transition teams are beginning their work and the implication for healthcare IT.
Selasa, 04 November 2008
The Last Lecture
Today on a plane flight to Orlando for the eClinicalWorks National meeting, I read Randy Pausch's The Last Lecture, the wisdom of a Carnegie Mellon Professor dying of pancreatic cancer. I highly recommend this book as inspiration for engineering, computer science, and IT professionals.
Although I never met Randy, he and I had the same cultural context - we were born six months apart and grew up nerdy. His lifelong dreams were
Being in Zero Gravity
Playing in the NFL
Authoring an Article in World Book
Being Captain Kirk
Winning Stuffed Animals
Being a Disney Imagineer
I remember watching the original Stak Trek episodes when they were first broadcast, spending my free time reading 1960's era World Book Encyclopedias from A-Z, sitting in front of the television with my neighbors watching Neil Armstrong's first steps on the moon, and marveling at how the special effects in Disney's Haunted Mansion were created.
What dreams arose for me from my 1960's life as a young geek?
Building the first bionic limbs
In middle school and high school I dreamed about bionics - the idea that biological systems and mechanical systems could be seamlessly combined to restore lost limbs. Throughout my life I've worked on pieces of this dream. As a high school student (1978) I designed computers that could measure human body signals and do real time signal averaging/fast fourier transformers that could be used to interpret visual and audio stimuli. As a college student I worked in a neurosurgery labs trying to understand the signals in the brain that coordinate movement. As a graduate student I designed robotic control systems. When I realized that limitations of 1980's computing capabilities and the lack of long lasting lightweight power sources would defer my dream for a few years, I turned my attention to electronic health records. The systems I work on today are a direct result of my early dreams of bionics.
Building and conversing with an Artificial Intelligence
In high school and college I experimented with the source code of ELIZA, the LISP-based computer psychiatrist. Although I never developed a witty interactive virtual companion, I learned a great deal about pattern matching and rulesets. The AI programming of the 1970's was the inspiration for the many decision support systems I work on today.
Immersing myself in Virtual Reality
As I kid, I thought that the analog world could be broken up into tiny digital fragments. If those fragments got small enough, human senses would be unable to tell the difference between reality and imaginary images - you could no longer believe anything you see. When I talked about this in the 1970's, my peers thought I was a little crazy. Today, my dreams of virtual reality directly inspire my passion for educational technology and simulation at Harvard.
Flying with an anti-gravity device
Many people wish they could fly. As a kid I imagined flipping a switch and riding my bicycle over the treetops E.T. style. At this point in technology history, we do not have any anti-gravity capabilities, but I believe my love of rock climbing and mountaineering is the terrestrial expression of my flying dream.
Being Henry David Thoreau
In my blog I've described my quest for simplicity, my veganism, and my dreams of a more green lifestyle. If you visit Walden Pond, you'll find a reconstruction of Henry's cabin with a plain pine bed, a desk, and his wooden flute. Every year, I aim for more time in nature and less complexity. Henry died of TB and my genome suggests I'm particularly susceptible to TB. Let's hope we do not share that in common!
Randy's book inspired me to reflect on my own dreams and how they've played out in my adult life as a CIO. Many of these dreams are still works in progress, which is appropriate since I'm only half completed with my lifespan. I look forward to the dreams of the next 46 years!
Thanks to Katherine Williams (originally Katherine Hoy), a friend from high school who recommended The Last Lecture and inspired this blog entry.
Although I never met Randy, he and I had the same cultural context - we were born six months apart and grew up nerdy. His lifelong dreams were
Being in Zero Gravity
Playing in the NFL
Authoring an Article in World Book
Being Captain Kirk
Winning Stuffed Animals
Being a Disney Imagineer
I remember watching the original Stak Trek episodes when they were first broadcast, spending my free time reading 1960's era World Book Encyclopedias from A-Z, sitting in front of the television with my neighbors watching Neil Armstrong's first steps on the moon, and marveling at how the special effects in Disney's Haunted Mansion were created.
What dreams arose for me from my 1960's life as a young geek?
Building the first bionic limbs
In middle school and high school I dreamed about bionics - the idea that biological systems and mechanical systems could be seamlessly combined to restore lost limbs. Throughout my life I've worked on pieces of this dream. As a high school student (1978) I designed computers that could measure human body signals and do real time signal averaging/fast fourier transformers that could be used to interpret visual and audio stimuli. As a college student I worked in a neurosurgery labs trying to understand the signals in the brain that coordinate movement. As a graduate student I designed robotic control systems. When I realized that limitations of 1980's computing capabilities and the lack of long lasting lightweight power sources would defer my dream for a few years, I turned my attention to electronic health records. The systems I work on today are a direct result of my early dreams of bionics.
Building and conversing with an Artificial Intelligence
In high school and college I experimented with the source code of ELIZA, the LISP-based computer psychiatrist. Although I never developed a witty interactive virtual companion, I learned a great deal about pattern matching and rulesets. The AI programming of the 1970's was the inspiration for the many decision support systems I work on today.
Immersing myself in Virtual Reality
As I kid, I thought that the analog world could be broken up into tiny digital fragments. If those fragments got small enough, human senses would be unable to tell the difference between reality and imaginary images - you could no longer believe anything you see. When I talked about this in the 1970's, my peers thought I was a little crazy. Today, my dreams of virtual reality directly inspire my passion for educational technology and simulation at Harvard.
Flying with an anti-gravity device
Many people wish they could fly. As a kid I imagined flipping a switch and riding my bicycle over the treetops E.T. style. At this point in technology history, we do not have any anti-gravity capabilities, but I believe my love of rock climbing and mountaineering is the terrestrial expression of my flying dream.
Being Henry David Thoreau
In my blog I've described my quest for simplicity, my veganism, and my dreams of a more green lifestyle. If you visit Walden Pond, you'll find a reconstruction of Henry's cabin with a plain pine bed, a desk, and his wooden flute. Every year, I aim for more time in nature and less complexity. Henry died of TB and my genome suggests I'm particularly susceptible to TB. Let's hope we do not share that in common!
Randy's book inspired me to reflect on my own dreams and how they've played out in my adult life as a CIO. Many of these dreams are still works in progress, which is appropriate since I'm only half completed with my lifespan. I look forward to the dreams of the next 46 years!
Thanks to Katherine Williams (originally Katherine Hoy), a friend from high school who recommended The Last Lecture and inspired this blog entry.
Senin, 03 November 2008
McCain and Obama on Healthcare IT
My blog over the past year has been silent about the Presidential campaign. Given the election tomorrow, I will write one blog reviewing the candidates statements about healthcare IT.
Both candidates have made supportive statements about Healthcare IT in the debates. To my knowledge, neither has specifically mentioned AHIC, ONC, HITSP, CCHIT, NHIN, or RHIOs. My HITSP role will continue through the change in administration until October 1, 2009, so I do not have any particular partisan bias.
How do they compare? Probably the best resource is the New England Journal of Medicine articles written by McCain and Obama.
Here's a summary of these articles, based on a text search of the word "technology"
McCain
"Quality: Strengthening health care quality requires promoting research and development of new treatment models, promoting wellness, investing in technology, and empowering Americans with better information on quality."
"We need to use technology to share information on 'best practices' in health care so that every physician is up to date."
Obama
"I am committed to making the fundamental changes necessary to modernize the system to streamline medical practice with the goal of improved patient outcomes. My plan calls for investing $10 billion per year over 5 years in health information technology. This commitment is not just financial: we will ensure that physicians have the technical support they need to implement new systems for patient records and billing. By reducing medical errors and unnecessary duplication of tests, this investment will lead to a long-term reduction in our health care system's overall cost."
"Finally, I will address medical malpractice with the central goal of preventing medical errors in the first place. Through substantial investment in information and decision-support technology and other patient-safety initiatives, we will reduce the types of medical errors and oversights that lead to lawsuits."
How about the candidate's websites?
McCain
On the front page of McCain's website, I clicked on the Healthcare Plan link on the front page. The word technology does not appear on the Healthcare Plan page.
I then used the search engine on the website to search on the keyword "technology" which yielded "no documents found". I searched on "healthcare" and got
"Error
We're sorry. There appears to have been an error with your request. Please try again or if the problem continues, please contact us.
If you were trying to connect to a McCainSpace site, you may have entered the web address incorrectly. Please remember there is no www" in a McCainSpace site. Simply replace the www with the name of the McCainSpace site (i.e.: http://SITENAME.johnmccain.com)."
Through Google I found a healthcare technology reference on the McCain website:
"Health information technology will flourish because the market will demand it."
Based on my experience in Massachusetts, I have not yet seen this market demand because incentives are misaligned - he who pays is not he who gains from Healthcare Information Technology. However, McCain's advisors may have a different experience from other states.
Obama
The second major tenent of the Obama healthcare plan is:
"The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention and care coordination."
As an unbiased observer, this brief review of the candidates suggests that McCain's plan for Healthcare Information Technology involves letting the market drive adoption because stakeholders will demand it. Additionally, physicians will be kept up to date. Obama's plan involves a $50 billion dollar investment in decision support, reduction of redundant testing, and minimizing medical error.
Whatever your decision, get out and vote tomorrow!
Both candidates have made supportive statements about Healthcare IT in the debates. To my knowledge, neither has specifically mentioned AHIC, ONC, HITSP, CCHIT, NHIN, or RHIOs. My HITSP role will continue through the change in administration until October 1, 2009, so I do not have any particular partisan bias.
How do they compare? Probably the best resource is the New England Journal of Medicine articles written by McCain and Obama.
Here's a summary of these articles, based on a text search of the word "technology"
McCain
"Quality: Strengthening health care quality requires promoting research and development of new treatment models, promoting wellness, investing in technology, and empowering Americans with better information on quality."
"We need to use technology to share information on 'best practices' in health care so that every physician is up to date."
Obama
"I am committed to making the fundamental changes necessary to modernize the system to streamline medical practice with the goal of improved patient outcomes. My plan calls for investing $10 billion per year over 5 years in health information technology. This commitment is not just financial: we will ensure that physicians have the technical support they need to implement new systems for patient records and billing. By reducing medical errors and unnecessary duplication of tests, this investment will lead to a long-term reduction in our health care system's overall cost."
"Finally, I will address medical malpractice with the central goal of preventing medical errors in the first place. Through substantial investment in information and decision-support technology and other patient-safety initiatives, we will reduce the types of medical errors and oversights that lead to lawsuits."
How about the candidate's websites?
McCain
On the front page of McCain's website, I clicked on the Healthcare Plan link on the front page. The word technology does not appear on the Healthcare Plan page.
I then used the search engine on the website to search on the keyword "technology" which yielded "no documents found". I searched on "healthcare" and got
"Error
We're sorry. There appears to have been an error with your request. Please try again or if the problem continues, please contact us.
If you were trying to connect to a McCainSpace site, you may have entered the web address incorrectly. Please remember there is no www" in a McCainSpace site. Simply replace the www with the name of the McCainSpace site (i.e.: http://SITENAME.johnmccain.com)."
Through Google I found a healthcare technology reference on the McCain website:
"Health information technology will flourish because the market will demand it."
Based on my experience in Massachusetts, I have not yet seen this market demand because incentives are misaligned - he who pays is not he who gains from Healthcare Information Technology. However, McCain's advisors may have a different experience from other states.
Obama
The second major tenent of the Obama healthcare plan is:
"The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention and care coordination."
As an unbiased observer, this brief review of the candidates suggests that McCain's plan for Healthcare Information Technology involves letting the market drive adoption because stakeholders will demand it. Additionally, physicians will be kept up to date. Obama's plan involves a $50 billion dollar investment in decision support, reduction of redundant testing, and minimizing medical error.
Whatever your decision, get out and vote tomorrow!
Langganan:
Postingan (Atom)