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Being John Glaser 2/18/09

February 17, 2009 News 3 Comments

The Stimulus Bill has been signed. The $19B healthcare IT portion is now official.

There will be Webinars, briefings, conference sessions, and blog postings galore as the industry tries to get its hands around the legislation and the challenges and opportunities that it presents. And it is appropriate that a whole lot of learning go on over the next several weeks.

As we all head up the steep part of the learning curve and enter a period of hype, anxiety, salivation, and confusion, we should be collectively thoughtful about several things.

First, it will take weeks and months before several important sections of the legislation are clear. It is not clear how states can apply for grants. The specific meaning of "meaningful use" is not clear. It will take the government some time to develop the regulations, policies, and procedures needed to fully answer the question, “What do I need to do?” Even after you’ve listed to ten Webinars, there will be holes in your understanding.

Should you wait for all to be made clear? No – you could lose valuable time. Some things are clear, e.g., e-prescribing is important and outpatient EHR implementations could be accelerated. Should you plow ahead full speed? No – some things are not clear enough, e.g., if I didn’t have a regional HIE, I wouldn’t try to start one tomorrow.

It will take some thought to figure out initiatives that should be pursued now and initiatives that would benefit from waiting a little bit.

Second, despite the near-term availability of funds, the factors critical to the success of an electronic health record implementation have not changed. Processes must be thoughtfully re-engineered. Clinicians must be meaningfully engaged. Giving these factors short shrift in a stampede to get money is not smart and could leave the organization with an EHR that has been funded by the government but has fundamentally failed since care improvement has not happened and the clinicians are angry.

Third, these funds, while large, are not infinite. At some point, monies for initiatives such as health information exchanges and research will probably go away. The country cannot afford a never-ending stimulus. Pursuing stimulus funds will require that those pursuing think through how they might sustain the activity once the stimulus bolus runs dry. Cheap/free capital can become an expensive operating budget.

The stimulus funds were meant to be spent. It is smart to pursue the funds. However it is not smart to be seduced by the prospect of buckets of money to the point that we forget that we have to balance moving forward with waiting. The fundamentals of care improvement through EHRs have not changed and capital investments bring operating budget hangovers.


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 "3 comments" on this Article:

  1. Mr. Glaser:
    Your comments usually have a point; today’s entry is very disappointing.

    I can’t figure out what it is you are advocating. Your intro, to paraphrase, says “get educated on the stimulus bill…but you’ll still be unclear”. Your first bullet point says basically….”should you wait?—NO; should you take action?–NO”. And your second bullet basically says, “Get the funds while available; but it could cost you more in the long run”.

    Another “Look before you leap” advocate is not what is needed here.

    Looking at both sides of an issue is ALWAYS prudent; No fodder for a column in that outlook. And offering a wishy-washy perspective like this is not up to your standards—all you do is contribute to the daunting confusion.

    In essence, you aren’t advocating anything. Don’t worry about being PC about issues like this. There are plenty in Washington who are good at that. What is needed is more advocacy, and influencers who will help shine a beacon to show the way….not just a caution light.

  2. As always with Washington’s ‘easy money’ – the devil is in the details…and Washington is great at creating big monster devils out of buckets of money.
    My advice is don’t make any commitments you can’t unwind from when the devil comes knocking at your door in six or nine months.

  3. John has a strong history of balancing the reality of EMR’s with the practical implications of their adoption though his work as the CIO of partners and hiw work at the National level so I would listen closely to his advice.

    It is amazing to see huge companies that advocate for market solutions to health care lining up to get their “share” of the HIT portion of the stimulus package. This should be viewed as venture capital and no one should receive any of it without a sustainable business model going forward.

    I would love to see new public private models of collaboration develop so that we don’t have a two tiered Health IT system in the country with rural and public health providers falling behind places like Partners where they can charge a 30% premium to their patient consumers simply due to their brand. (vs quality outcomes).

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