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Following is from Richard Steen, a Healthcare industry consultant from IBM.

The Obama administration’s stimulus program, with $19B in incentives for EMR and HIE adoption, has the potential to provide a real “shot in the arm” to our country’s healthcare IT infrastructure.  As barriers to EMR adoption lower, the nation’s health information topography could evolve organically as a virtual “neuro-net” connecting overlapping communities of interest. 

Less obvious is the developmental path for governance models that will surely be required to regulate data owners, gatekeepers, custodians, and permitted uses of protected health information.

Healthcare technology has gained prominence and capability amidst decades of highly touted healthcare reformations, such as Capitation, “Pay for Performance”, CHINs, eCommerce, and more recently RHIOs, HIEs, NHIN, and Medical Home.  Health IT has grown from “cottage industry” infancy to adolescence, perhaps characterized as siloed “coopitition”.  Now, health IT helps provider networks increasingly compete for self-referring physician networks and target patient cohorts who are more healthy, young, affluent, or substantially subsidized. 

Now envision a future where medical information is pervasively and securely harnessed for benevolent purposes: e.g., patient-centered care, prospective and retrospective analytics benefiting research and population health.  How is our country’s healthcare ecosystem destined to evolve over the next decade?  How will society apportion responsibility for safeguarding the “public good” while addressing myriad challenges, such as security, reliability, usage, ownership, and liability?

If we could reflect back from 2020, would 2009 be the inflection point, spawning a transformative revolution in healthcare, where stimulus (carrot) and regulatory (stick) controls prompt collaboration among normally competing stakeholders in our ecosystem?   Will a vibrant, information-driven economy emerge towards 2015 supported by quality outcomes measurement, patient-centered collaborative care processes, and securely supported by standards-based technology?  Will collaboration be sustained with an enduring commitment to private/public governance at community, state and federal levels? 

For US healthcare reform, the next decade may be analogous to the “Gold Rush” of the 1870s.  Short term, state governors and health information exchanges in proactive “medical trading areas” will compete to be early beneficiaries of Uncle Sam’s largess.  Long term sustainability will depend on innovative and inclusive community governance that rewards best practices and represents local healthcare (and economic) priorities.

Short-term winners will be communities and states prepared to mobilize quickly through an engaged and collaborative governance structure, and able to present a responsible strategic vision. The stimulus funding and other agency regulatory reforms have transformative potential to remove barriers and realign incentives across our healthcare ecosystem.  Challenging to realize, and far easier to derail, this round of healthcare reform will succeed or fail based on the commitment level of every citizen, employer, health professional, and government representative. 
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Richard Steen photo
Richard Steen is a healthcare industry consultant in IBM Global Business Services Strategy & Change group.

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