Dale Sanders, CIO, Cayman Island Health Authority
Before I levy my criticisms on Orszag and the mess that his philosophies will leave behind for healthcare CIOs, you need to understand that I’m as politically liberal as they come. I voted for Obama and celebrated in Grant Park when he was elected. However, while I’m a spendthrift with my money, I’m a tightwad when it comes to spending other people’s money, and therein resides the problem that Peter Orszag created for healthcare CIOs.
Unless we pause now and deliberately change course, Peter Orszag’s economic policies are going to leave healthcare CIOs with a crop of under-performing, over-priced electronic medical records and surrounding products. While Osrzag leaves his current position at OMB to chalk up another score on his glowing resume, his think-tankish, economic behaviorist policies are going to leave the rest of us with a giant mess and healthcare in the US will suffer.
Orszag is the outgoing Director of the Office of Management and Budget under the White House. He was in that position for a very short period—not even two years–starting in November 2008, but in that time frame, drove the economic policies behind the White House and designed the Obama budget, including HITECH funding. His background is as academic as they come– and I would give my right leg to share—Exeter, Princeton, London School of Economics. Orszag believes that healthcare spending is at the root of the US economic meltdown, which may not be entirely true, but I concur it is to a large extent. He was also a key architect in the bailout of the banks and automotive industry. In a recent interview with John Stewart, the non-academic Stewart asked the highly-academic Orszag to explain why more of the ARRA funding didn’t flow directly to the consumer—why must the money pass through the banks first, in the hope that it would eventually make its way into the hands of the average citizen with a failing mortgage? Orszag replied, “Because you don’t want to create an incentive [in consumers] for defaulting on their home loans.” Stewart’s eyes illuminated at the irony and he howled in laughter. The brainy Orszag was caught with his economic pants down.
There are two extremes of political-economic thought—democratic capitalism advocates think that hands-off, free-enterprise business will eventually benefit the populace and world—less government is better. Socialism believes in cooperative ownership and governance of wealth and business, all for the common good—more government is better. It’s pretty clear to me from empirical evidence that neither extreme works, and that the most successful countries in the world today are a mixture of both, with the socialist-leaning horses leading the race by half a length.
I would assert that Orszag’s $19B in HITECH funding, a cornerstone of his strategy for addressing the ever-increasing costs of healthcare, has gone too-far socialist and will strangle the efficiencies and creativity of free-market capitalism out of the EMR market…unless we pause now to withhold some of those funds and invest them– venture-capital style– to seed development of a new generation of EMRs that reflect a new model for healthcare delivery. There are numerous models in government for successfully funding innovation—DARPA is the best example. DARPA takes advantage of government power and free-market ideas, balancing capitalist and socialist economics extremely well.
Dr. Blumenthal—Return some free-market balance to the healthcare IT economic model. Don’t let Peter Orszag’s economic policies drive healthcare IT into the mud of mediocrity for the next 20 years. Withhold some of that HITECH money and invest it in innovation—create a DARPA for healthcare IT please!!
Evan Steele, CEO SRSsoft says
You can remind your readers that Peter Orszag is quoted in a Congressional Budget Office study, (page 3 of http://www.cbo.gov/ftpdocs/95xx/doc9572/07-24-HealthIT.pdf ), that was submitted to the House Ways and Means Committee, saying that “office-based physicians in particular may see no benefits [from traditional EMRs] and may even suffer financial harm.” Somehow, this piece of advice was overlooked!
Brian Ahier says
A very thought provoking piece, Dale. Regarding a DARPA for health IT, I think that is the point behind the SHARP funding, but I’m certainly with you that free market balance needs to be restored to the industry, or we could continue sinking into a terribly deep hole.
Dale Sanders says
Nice find on the quote, Evan. Very interesting and it does seem a bit ironic. And yes, Brian… that’s the idea behind SHARP as I understand it, too. But the funding for and emphasis on “SHARP-as-DARPA” is anything but DARPA– it’s an afterthought. If HITECH and SHARP managed to do ANYTHING useful, they should stimulate the development of a new EMR that supports: (1) Physician/clinician efficiency of workflow; (2) Evidence Based Medicine; (3) Patient engagement in their own care; (4) Economics of care at the point of care; and (5) Paperless, simplified billing with no need for coders.
What DARPA does for Defense, we need. What Salesforce.com does for industry, we need.
Healthforce.com.
tcaruso2 says
I get that your perspective as a CIO indicates to you that the health IT market will be less innovative due to the HITECH funding. My perspective on the software development side of the HITECH funding, where I am watching the transformation of the health information and management systems community focusing them on a boom in the EHR market and the increased competition that this means, is stimulating innovation. I see innovation in new tools that provide information integration including renewed interest in standards like ICD-10, HL7 RIM 3, SNOMED CT, NLM’s UMLS, NCI’s EVS, and the Semantic Web; innovation in provider training and the resulting innovation that result from the feedback concerning the user interface; innovation in the interface between different Federal government agencies that work with medical information including CMS, FDA, VA, NIH, ONC, OCR (Office of Civil Rights) and DOD; and, maybe most importantly, innovation in privacy protection.
The HITECH strategy is further increasing the numbers pursuing careers in health information and management systems and biomedical informatics, the innovation that integrates health informatics with biomedical research information driving personalized medicine. The numbers of new people will spin off from larger companies that teach them the business and they will create new innovative companies that deliver Web 2.0 and beyond, including PHRs and mobile health technology.
HITECH is driving integration and this is an innovative force in the development of new technology.
Dale Sanders says
Tom,
If I were Dr. Blumenthal, I’d dangle $500M in front of Amazon, Google, Nintendo, Facebook, salesforce, eBay– or any other capable body– and sponsor a shoot out: Build an inpatient/outpatient EMR and financial management system that will rock our world.
In the rush to incentivize adoption and certification of EMRs, there is a commensurate rush to purchase known and “safe” products– the market leaders with typical solutions–and that will be a disaster. Many of the top EMR vendors themselves will tell you behind closed doors that they are not necessarily proud of their products, but they keep selling, so there is no incentive for them to stop producing.
The current HITECH focus on investment in integration is putting the cart before the horse….we need better horses, first. The measurable and sustainable value provided by HIE’s is the reduction in redundant lab tests. That’s as far as we need to go with HIE’s at the moment, and that’s a relatively simple technical solution that the insurance companies offered to providers many years ago, but providers rarely accept.
We are taking on massive federal debt to invest in a crop of mediocre products. Here’s the ironic scenario that I see: Five years from now, when almost everyone is running on EMR products designed around paper charts; and inflexible client-server, message oriented architectures, there will be a new and better product on the market, probably produced in another country, which is better than anything else on the US market… but no one in the US will have the money or willpower to adopt and adapt it for the US, because they exhausted themselves under the current HITECH strategy of Now, Now, Now. Let’s ensure and accelerate the development of that better product in the US and hold-back some funding to make its adoption possible.
We don’t need more medical informaticists. We need hardcore computer scientists and engineers, like the kind going to work for salesforce.com, Nintendo, Facebook, Amazon, and Google. It’s much faster for the supply chain of labor to teach great healthcare to a computer scientist, than it is to teach great computer science to a physician or nurse. No offense to my many doctor and nurse friends, most of whom would agree.
I’m not saying that we will receive no innovation from HITECH. I’m saying we won’t get as much innovation as we need or could, unless we set aside more funding and manage it properly to stimulate true innovation in healthcare IT.
Jorge Grillo says
I have to agree with Dale’s comments. The gov’t is just not structured to develop or certify an EHR or integration strategies. Just look the BILLIONS the military spent with SAIC, EDS, and other companies on an integrated clinical system (CHCS). While they were definitely leading edge, they ended up spending significantly more that than Siemens did on the Soarian effort with a debatable product.
If we look at what is needed, Dale is correct that the software development houses like Google, Microsoft, or others are much better staffed and experienced in developing an innovative approach than any gov’t lead effort.