I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in June 2006.
Consider Funding Health IT Projects Like Bill Gates Would
by Mr. HIStalk
It’s no longer news when a big, non-profit integrated delivery network pays a CEO $1 million or a CIO makes $300K for running a small department. We’ve come a long way since the days when ministering to the sick was a calling, where selfless caregivers toiled for a subsistence wage in service to mankind. And why not, since a big IDN can make hundreds of millions of dollars in profit (sorry, “surplus”) in a good year? Once nuns got replaced by MBAs, hospitals became a big business, feeling quite unlike charities to those working inside them. The only surprise in the IRS’s questioning of whether hospitals deserve tax-exempt status is that it took them so long.
VP panic ensues when the local newspaper prints executive salaries, fiscal year results, or drawings of the latest vanity construction project. Nurses may be de-motivated. Unions might be called in. A bitter janitor might key all the luxury cars in reserved spots. Beaten-down doctors may get even crankier when they find out that even bottom-feeding HR and marketing VPs out-earn them.
I thought of this when I read that Bill Gates and Warren Buffet will turn over their billions to serve those in need. I’ve worked in hospitals and IDNs for many years. Are we good stewards of charitable dollars, efficiently funneling them directly to those in need with minimal administrative overhead and waste? That’s how you evaluate a charity, and on that basis, IDNs don’t seem to compete very well. We’re no Salvation Army, with tiny salaries and a focused mission.
Still, another headline gave me an idea. Studies are proving what we all knew: RHIOs can’t survive without charity. If RHIOs provide benefits to patients, yet offer no hope of financial self-sufficiency, then maybe that’s a good and direct use of charitable dollars. Put a few million long-term dollars into some well-organized RHIOs and see what happens.
I like this because Gates’s charity is notoriously efficient. You compete with other causes under rigorous conditions on how well your project will benefit society. RHIOs would have to prove themselves worthy of funding, which would be an interesting exercise in itself given their sketchy “let’s put on a show” origins.
What other health care IT projects deserve charitable consideration? I’d vote for a center for usability research to make health care software more user-friendly and less training-intensive. I like the idea of a free clearinghouse for clinical rules, knowledge, and content to be shared by non-profit hospitals. Maybe we need a patient safety organization just for IT, watching out for problems caused by poorly-designed software and medical technology. Perhaps a non-profit medical informatics consulting organization could help hospitals with an occasional need for that expertise..
If you’re involved in hospital IT, my advice is to review your projects like the Gates Foundation would. Are they ingenious, cost-effective, highly beneficial to patients, and highly likely to succeed? If so, put your resources into those.
In the meantime, here’s my challenge to you. Come up with a list of health care IT projects that are noble causes, benefiting a large population in a way that the free market and the government haven’t. What IT-related work would be ingenious, cost-effective, highly beneficial, and highly deliverable enough to pass scrutiny from the Gates Foundation? Send them my way and maybe we’ll talk about them in a future article.