Tuesday, March 18

Guest Post by Darren Dworkin Cedars-Sinai Health System - Attending HIMSS Made Me Wonder: Does IT Matter?

HIT from the CIO's Chair

Attending HIMSS Made Me Wonder: Does IT Matter?

Written by Darren Dworkinon Wed, Mar 12, 2014
Originally posted on NextWaveConnect -
Attending HIMSS Made Me Wonder: Does IT Matter?
Flying home from HIMSS after spending a week in Orlando and reflecting on the conference it made me think about Nicholas G. Carr’s book from over 10 years ago that made everyone it IT defensive. Mr. Carr asked, with a provocative title, Does IT Matter?
After spending a few days on the HIMSS show floor, the collective group of exhibitors might have colluded to try to make Mr. Carr’s point.
Before I run the risk of losing my secret CIO decoder ring (which gives me wide, sweeping powers to say “no” to things, an important task of a CIO), let me skip to the end and say, “Heck yes, I think IT matters.” But it sure was hard to see at this year’s show.
Let me add context. Mr. Carr never claimed that IT didn’t matter. People who only read the title of the book argued thinking that, but his main point was that IT yielded diminishing returns as a continuing source of strategic differentiation.
Since I already shared that I don’t agree with his thesis and I think that IT does matter, let me explain more why it was hard to hold my ground at HIMSS.
I believe that real strategic value from IT comes from cumulative and sustained use of our systems.
The show floor at HIMSS is best at being a live shopping catalog. If strategic value comes from health systems hunkering down and “just using what they own,” it really means we should all be at our core vendor’s user group to get focused instead of out shopping. This is not to say that there weren’t some interesting new ideas and companies at the show, but I would contend that most health system should be implementing, optimizing, or perfecting the use of their existing systems.
The problem with not staying focused is that it makes us forget that IT is only a tool, not a panacea. Shopping for the latest technology because it can be installed now does not usually translate to having our problems magically solved. 
Especially for those institutions that have achieved MU Stage 1 or HIMSS EMRAM Stage 6 or higher, the goal really needs to be to make use of everything we have by using our systems more deeply. Most big vendors I talk to often complain that they have trouble getting their existing customer base to either stay current on latest versions or to implement and use all of the already-live functionality.
But it is not simple. New technologies will continue to give companies the chance to differentiate and first movers who take risk will gain advantage. But understanding the opportunity and deciding when the right time to make the bet is not for the faint of heart. It is among the toughest choices for CIOs and the rest of the C-suite to make these days, with constrained budgets and scarce ROI from previous large IT projects.
Mr. Carr makes the claim that widespread adoption of best practices through the use of IT software makes advantages disappear. It is obvious to me that Mr. Carr never spend time trying to enforce common content in a large health system. If he saw our slower pace, he would certainly declare we had a long way to go and had a low risk of IT not mattering.
The reality is that a lot of the IT mystique has been eliminated as consumer use of technology continues to grow. IT teams now need to play by the same rules as other business units by having clear objectives before money is spent. The age of technology for technology’s sake is probably in the rear view mirror. As technology infrastructure becomes a commodity (the cloud), how we use our tools or the depth of our use of IT will define and create our advantage.
Adding to the challenges of the CIO will be the realization that just because we find a new innovation, it does not necessarily mean that it will pay to be a pioneer. Our focus might be better spent on hunkering down and optimizing.
If we are going to make IT matter, as a mentor once told me,“Let’s get ‘er done.” Then we can go shopping.

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Sherry Reynolds - Director - Community Management - MU, ACO, PE, SN
Attending HIMSS Made Me Wonder: Does IT Matter?

Great post and spot on Darren.

Many of my friends in the startup community call it the bright shiny object addiction - people want to run after the latest new toy (okay take off your google glasses right now) instead of developing the skills required to improve processes and motivate people along with integrating existing technology.

6 Minutes ago 
Drexel DeFord
Attending HIMSS Made Me Wonder: Does IT Matter?

Wring out the existing capability -- get everything you can out of the tools you've already purchased. The best vendor partners (at least during my life as a CIO) were the ones who were trying to help me, and my business partners, realize more of the value/capability of the tools we already had. Then, when it was time to go shopping, I often went back to those partners first.

Nice blog, D. Thanks.

4 Days ago 
Tom Smith - ACE
Attending HIMSS Made Me Wonder: Does IT Matter?

Darren, I agree that once most large systems selected an EMR vendor the purpose of HIMSS 'shopping' changed a lot and attending the EMR user group did become more important. Most EMR vendors can code faster than providers can install and most users are 'falling behind' from the vendors' perspective. Most of us have a lot of the EMR we have not used well yet.

Maximizing the use of the existing product you already own is probably a better use of your IT time than buying something new and trying to interface it. This, of course, assumes that your EMR vendor is keeping up with the needs that come from ACOs Population Health ,etc.

4 Days ago 
Biff Burrmeister
Attending HIMSS Made Me Wonder: Does IT Matter?

Sage advice Darren. I have stated several times that I believe most organizations are using less than 50 percent of their software systems capabilities. I have to be careful and qualify that by also saying, that in many cases the software still doesn't have the workflow flexibility for many organizations to implement additional capabilities. But in general, we need to figure out how to optimize the use of what has been implemented. Nice blog; looking for additional insights from you.

5 Days ago 

Monday, March 10


A friend / colleague of mine posted this and although I don't agree with the conclusion and the data is somewhat dated,  I think his view is pretty common among many in healthcare and I could use your thoughts on how to respond..


Can Patients Really Understand Their Own Health Care - and where do they get their information?

Written by Lynn Vogel - ACEon Sun, Mar 9, 2014
The previous blog posting focused on data documenting levels of participation (or Activation) among adult members of the U.S. population, noting differences among age groups and those with chronic illnesses. The HSC study referenced in the previous posting is a good source for understanding how patients’ participation in their own health care varies by age and chronicity of illness, but it does not provide insight into the capabilities of patients to participate in their care.  For insight into this question we turn to a study released in 2008 by the Agency for Healthcare Research and Quality (AHRQ) based on data collected several years earlier and reported in their 2007 National Healthcare Disparities Report.[1]  In this study, the AHRQ noted that in the general population,
14 percent had below basic skills, meaning they could accomplish only simple tasks such understanding a set of short instructions or identifying what is permissible to drink before a medical test.
22 percent had basic skills, such as being able to read a pamphlet understand two reasons why a disease test might be appropriate despite a lack of symptoms.
53 percent had intermediate skills, such as being able to read instructions on a prescription label determine the right time to take medication.
12 percent of adults have proficient skills to manage their own health care; this includes weighing the risks and benefits of different treatment knowing how to calculate health insurance costs being able to fill out complex medical forms.
At the time of this study, 36% of the population had basic or below basic skills at the low end of the scale, while only 12% actually had the capability to manage their own health care. While access to the Internet may have increased the level of “health care literacy” among the U.S. adult population somewhat since this data was collected and analyzed.  However, where patients get health care information has not changed significantly over the past several years, even with many more sources and, through the Internet, more access.   Another recent study by the Center for Studying Health System change documented where patients seek health care information:
 In 2010, 50 percent of American adults sought information about a per­sonal health concern, down from 56 percent in 2007, according to a new national study from the Center for Studying Health System Change (HSC). The likelihood of people seeking information from the Internet and from friends and relatives changed little between 2007 and 2010, but their use of hardcopy books, magazines and newspapers dropped by nearly half to 18 percent. While the reduced tendency to seek health information applied to consumers across nearly all demographic categories, it was most pronounced for older Americans, people with chronic conditions and people with lower-education levels. Across all individual characteristics, education level remained the factor most strongly associated with con­sumers’ inclination to seek health information.[2]
The summary chart for this report is provided below:  
As if to add to the challenges of involving patients in their own care, even the popular press cites statistics about patients’ lack of follow-through and continuing compliance with clinicians’ recommendations.  One recent article made the following observations:
One in five patients fails to fill new prescriptions, and half of those being treated for chronic conditions stop their medications after six month, according to the National Institutes of Health.  These lapses result in additional treatments and hospital stays that cost as much as $289B a year, according to NEHI, a Cambridge (Mass.) health policy group.  On top of the expense, missed doses cost an estimated 125,000 U.S. lives a year.[3]
By any account, the facts about patients’ participation in their own care are discouraging.  While there may be a myriad of reasons (often highly individualized) for why there is such a significant lack of participation, even among persons with chronic conditions, and even with the assumption that higher levels of participation lead to better, more effective and efficient outcomes, the fact remains that this situation adds to the complexity of providing care.  And while patient portals, telemedicine and home-based medical devices all seek to minimize this complexity by providing opportunities for participation and seeking to make participation easier and more convenient, it remains a significant challenge.


[1] Only About 1 in 10 Adult Americans Have all the Skills Needed to Manage Their Health. AHRQ News and Numbers, May 14, 2008. Agency for Healthcare Research and Quality, Rockville, MD.
 [2] Tu, Ha T., Surprising Decline in Consumers Seeking Health Information, Center for the Study of Health Systems Change, Tracking Report No. 26, November 2011.
[3] Monitoring Pills to Reduce Bills, Bloomberg Businessweek, April 1 – April 7, 2013, p. 51.