In Boston for Harvard Leadership Strategies for Information Technology in Health Care

After 24 hours in the air or in an airport I finally arrived in Boston on Sunday night. As we landed the captain announced the outside temperature was zero degrees fahrenheit, which translates to -18 Celsius. That is cold!

I am attending the week-long residential class being run by Harvard School of Public Health on Leadership Strategies for Information Technology in Health Care. It was recommended to me by Mal Thatcher, the CIO of Mater Health in Brisbane who attended it last year.

Bright and early Monday morning about 60 of us crowded into the ballroom at the Colonnade Hotel in Boston. It was still well below freezing outside so the warmth of the meeting room was very inviting.

The class consisted on people from around the world, 2 of us from Australia, some from Ghana, some from Spain, someone from Nigeria, a few from Canada and quite a few from the USA. They ranged from physicians to software engineers. Quite a few CMIOs, some CIOs and even a few of us from industry.   

The first presentation was from Violet Shaffer from Gartner who took us through the history of the health IT industry and how it paralleled the IT industry. Interesting that Cerner Epic and Meditech are all now about 30 years old and how they started based on the ideas of their founders. She spoke about the Gartner Hype Cycle and how health IT has followed that cycle over the last couple of decades.

She was followed by John Glaser, previously CIO of Partners Healthcare and now the CEO of Siemens. He spoke about what strategy is, how it relates to health IT and how we need to tie IT governance to the business needs of the organisation.

This was emphasised by  the next speaker Chuck Gibson from MIT who told us about the need for change management to understand what is needed to not only influence the heads of those who are involved, but also their hearts.

Finally John Glaser came back and we spoke about Accountable Care Organizations (ACO) and the IT strategy that relates to them.

For those of you in Australia, the ACO is basically the American equivalent of our Medicare Locals. It is an idea for corralling people into coordinated care by having a group of physicians or other care provider organisation take responsibility for a population. Basically the provider becomes accountable for the quality of care, and the outcomes delivered to a defined population. Lots of debate on whether it is a good thing or a bad thing, but most importantly we saw the complexity of the IT strategy required to make it happen.

 I spoke about the Australian Personally Controlled Electronic Health Record (PCEHR) and how in Australia that can provide the basis for the Medicare Local experience.Dr Glasser made a very good point based on the recent article by Atul Gawande in the New Yorker titled “The Hot Spotters”. In that article Gawande asks “Can we lower medical costs by giving the neediest better care?” He notes that in Camden New Jersey one percent of the population is responsible for 30 percent of the healthcare costs. His comments were that an opt in voluntary PCEHR that needs people to fill it will not be used generally by this portion of the population. So unless we can get them to share their information, we cannot run the analytics we need to identify them. So clinician led Health Information Exchanges (HIE) may be the best way to get the relevant information in one place to enable this type of analytics to be done.

The US experiment with HIEs versus the Australian experiment with the PCEHR as the means of sharing health information is an interesting one. The US model is under the control of the powerful healthcare provider and payer segment, who have an incentive to make the system more efficient. In Australia the responsibility falls with the patient, and they have all the right incentives to make care more effective and efficient. I will watch with interest and see which model takes off first.

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