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Being John Glaser 8/31/09

August 31, 2009 News 8 Comments

If you had to answer the question below in one sentence, what would you say?

What is the fundamental contribution of information technology?

My answer — information technology enables complexity.

Our personal financial assets are much more complex that those of our grandparents; savings accounts have been replaced by retirement plans and mutual funds that can automatically shift assets based on a person’s risk tolerance. Handwritten flight manifests have been replaced by the ability of an individual to book air travel involving multiple stops and carriers. Weather forecasting based on seasonal expectations and reports from adjacent states has been replaced by sophisticated models. Complex activities such as sending a satellite to Jupiter, non-invasively observing metabolism in the brain, and simulating the interactions between proteins would not be possible without information technology.

These problems of healthcare cost, safety and quality are based in and exacerbated by the complexity of healthcare. The knowledge domain of medicine is vast and evolves rapidly. Patients with complex acute problems and multiple chronic diseases will be seen by many providers within a short period of time and undergo several parallel treatments. The delivery system is highly fragmented and dominated by small physician groups and hospitals. Standardized care processes have multiple varieties. Managed care contract provisions can fill volumes.

Information technology can be applied to enable the complexity in healthcare. Clinical decision support and clinical documentation applications can assist the provider in keeping up with medical evidence. Results management systems can highlight the patient data that deserves the most attention. Interoperable electronic health records can support the coordination of multiple providers taking care of an elderly patient. Telemedicine can assist patients and providers in joint management of chronic disease.

Maybe that’s the fundamental contribution of information technology in healthcare. It might enable the current complexity to actually work.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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Currently there are "8 comments" on this Article:

  1. Thanks so much John for the reminder that A. the passage of a patient’s Healthcare information for improved outcomes is a maze, not a tunnel, B. It is a very long and complex maze managed by multiple “Keepers” with divergent secret codes required for passage with no apparent motivation for said keepers to gain concensus as to format or content and, C. Though the distance from start to finish is short, the route from beginning to end is long, frustrating and at times, seems hopeless!

    Sorry if I misinterpreted the message!

  2. I agree that IT has allowed greater and greater levels of technical complexity, but unfortunately IT itself layers on yet another level of complexity.

    So lets not forget:
    The best answers to problems are usually the simplest, and that old adage I first learned in systems class – KISS- Keep it simple stupid!

  3. I appreciate the view but would express it differently.

    I take the view that IT facilitates people in handling complexity; by itself, IT is not an enabler. Skilled people are the enablers, especially in fields such as biomedicine.

    A minor semantic quibble, or an important distinction?

    I believe it is important to distinguish enablers vs. facilitators, for if you have a confused or reversed understanding of these roles, whether about technology or people, it can affect decision making (for example, about priorities) in a possibly adverse manner.

  4. JH illuistrates what is destroying the doctor patient relationship. The reams of rubbish inundating doctors from hospital administrators who want more scans, insurance carriers that deny admissions, pharmacy benefits managers that educate on the use of statins, medicare surveys, to triplicate test reports generated by puking computers is what makes health care complex. Halamka’s own doctoprs complain and laugh about the care system he runs.

  5. I always preferred Keep It Simply Smarty.

    Getting onto the topic I see IT a little differently. Yes, handling complexity is one attribute but what may be even more important is the ability to collect data for post analysis. You can’t improve what you do not measure thus it is not too surprising that the healthcare sector, so woefully behind other industries in IT adoption is in the mess it is today.

  6. While there is no denying that IT systems can do a better job of tracking large amounts of complex data, the data being tracked in health care is not airline schedules or weather data but rather an
    individuals most personal information. Current HIPAA regulations allow a wide distribution of this personal information. Until the patient has control over what is included in their EMR and who gets to view it there will never be patient acceptance of these systems. Sophisticated patients may exclude critical information they do not want public from their physicians making the EMR a dangerously incomplete document.







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