The dangerous thing about being a water-walker is that when people see you walking on water one of them is bound to shout, “The reason he is walking is because he cannot swim.” It is sort of everyone’s Chicken Little moment. And, instead of continuing to walk on the water when those around you are swimming, it is easier on your career to simply learn how to swim.
Several people have written me about my last post as to whether the hospital business model is capable of deploying an accountable care (ACO) organization once EHR is implemented. The gist of the comments can be summarized as follows:
- The current hospital business model is dysfunctional; as compared to other industries, hospitals are run more like a 0.2 model than a 2.0 model
- EHRs were built to support a dysfunctional model, and those EHRs are built using outdated architectures
- An ACO business model is not compatible with the present crop of EHRs—EHRs were not built with ACOs in mind—they are mutually exclusive concepts, at least with regard to today’s EHRs
- For and ACO to be of value, to be effective to an organization, they must be joined to a different business model
That should lead us to question which model is more important; a model that will support ACOs, or the same old model hospitals have been running for the last 30 or 40 years. Now, before anyone tries to argue semantics, the term “old” refers to how the hospital’s business is run. It does not refer to the quality of care it can deliver.
For example, installing Lawson or SAP did not improve the business model. All it did was deliver an accounting of how the model operates.
There is a parable which states one should not put new wine into old wineskins because it will cause the wineskins to burst. A similar parable states one should not patch an old garment with a new piece of material or the garment will tear. Not exactly rocket science.
The same adage works with large information systems. Just because it is possible to add a large application and make it interface with existing applications does not mean the new system will offer the desired functionality. As soon as you are forced to utter the phrase, “This is how we get the system to do this,” you have lost the battle.
What hospitals need today from their CIOs are some water walkers, some who deny conventional wisdom and tell the other C-Suiters how IT works, and how it doesn’t. Tell them just how much value EHR will really add to their organization. Tell them what they need to do in order make an ACO model work. If the CIO merely acts as an order taker, salutes the flag, and marches off to try to deliver to them an ACO model that they know will work poorly at best under the current architecture, what value is that?