The most effective advocate is not the individual who “from the beginning” has spoken out in favor of a cause, but one who previously occupied the opposing ground. If that person also happens to hold an influential position, and is respected for outstanding vision, honesty and pure motives, the opinions offered are doubly compelling.
Readers of this column will remember my recent post on the resignation of John Halamka, M.D., from his position as CIO of Harvard Medical School, a duty which was receiving 50 percent of his time and attention. Though it’s doubtless 50 percent of Halamka is equal to 100 percent of most individuals, it became clear the position had grown beyond the capacity of even his seemingly boundless energy. Halamka will remain CIO of Beth Israel Deaconess Medical Center in Boston, and continue in his myriad other activities with the government, industry and the international HIT community. I interviewed him on Tuesday and our discussion will be published shortly.
As part of my interview preparation, I reread many of Halamka’s blog posts. As I moved from column to column, from month to month, I began to feel an evolution in his attitude toward government efforts to prod the industry ever faster and further towards automation. Since I can remember, he’s been a major cheerleader for healthcare IT, almost never taking issue with government policy and initiatives. This always irked me a bit because I have complained about HITECH since its liberally used ink dried. When the Stage 1 measures came out, I thought they constituted far too high a bar for the average community hospital and, thus, would exacerbate the digital divide separating large academic medical centers from everyone else. (Marc Probst thinks so too).
A first sign that Halamka’s ever-rosy thinking was changing came with a post which included comments on ICD-10. On March 25, he wrote: “My personal opinion is that we should defer the work on ICD-10 while we’re navigating meaningful use stage 1, 2 and 3. Accurate coding requires comprehensive clinical documentation on the front end including adoption of clinical vocabularies such as SNOMED-CT. Let’s enhance our front end documentation before thinking about the back end coding.”
More recently, Halamka joined many (almost everyone, actually) in a sound savaging of HHS’s Account of Disclosures NPRM. This was embedded in a post that overall took issue with the pace of change being forced upon the industry by government. Yesterday, he made the case that healthcare is simply different and cannot be measured by the same yardstick applied to other industries.
When I interviewed Halamka, he admitted that, yes, his thinking was changing. Yes – it was all becoming too much for the industry and the CIO who must facilitate it. In fact, he said that with the exponentially increasing complexity of everything falling under its purview, “The CIO position will become untenable.”
For those feeling that the burden is already quite untenable, Halamka’s conversion is good news. When someone who’s continually been saying that just about everything can be done starts saying some things can’t (and shouldn’t), very important ears perk up. A few hundred columns from me bashing CMS and ONC won’t have much effect because, at this point, it’s expected.
“There he goes again,” opponents might say dismissively.
John Halamka, however, is no cynic. In fact, a more optimistic, positive and can-do individual I have never met. But while aspirational in nature, Halamka’s day job keeps him realistic in practice. And whereas many on the HIT Policy Committee don’t have to live with the regulations they flesh out, Halamka does (he sits on the Standards Committee). As such, it’s all very real to him.
A few months ago, I wrote that HIT Policy Committee Co-Char and Meaningful Use Workgroup Chair Paul Tang, M.D., had seen the light and become a voice of caution about overburdening the industry. I think Halamka is the latest convert to what will hopefully become a chorus of influential can-do voices that are now recommending brakes be applied to the government’s multi-faceted and runaway healthcare-reform train. His voice, and others, will doubtless reach the right ears. We can only hope, at that point, they listen … and learn.
Will Weider says
I completely agree. There is much to be admired about John. He is the most prolific person that I can imagine. He is frequently the first one to tell everyone to charge the hill, which appears to be his greatest attribute and failing. I have disagreed with some of his advocacy (e.g., CPOE using the current generation of products). So, when I hear him say that an effort is too much effort given the other priorities, then people should believe him. The two areas you cite are defintely areas of poor prioritization.
Because Halmka is so influential it is important that his advocacy is not only based on a conceptually a good idea, but they also need to be achievable given the other priorities in the healthcare industry.