Time Capsule: The HIT "Trendulum" Starts its Swing

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 August 2007.

The HIT "Trendulum" Starts its Swing
By Mr. HIStalk

Anyone who’s worked in healthcare IT for a long time knows about the often-mentioned pendulum (or "trendulum", as I call it). It swings one way, reaches its maximum travel, and then starts its swing back in the other direction. Some examples have been:

• PC desktop vs. thin client
• Midrange/mainframe vs. PC
• Own vs. lease
• Build vs. buy
• Outsource vs. bring it back in-house

I’m not sure why there’s a pendulum. Probably because providers are limited in capital, project resources, and institutional focus, thereby making it impossible to get IT projects done until the need for them reaches a crisis level.

Four or five years ago, the pendulum finally swung back on clinical applications after a long absence. The formerly hot enterprise resource planning, budgeting, and financial systems cooled off in favor of patient care systems.

Magazines started fawning over CPOE and forming RHIOs for clinical data sharing. Maybe it really was a trend, or maybe reporters just got tired of writing about administrative systems. Toss in some eager consultants and feel-good politicians and suddenly the only systems that mattered were clinical.

It’s hard to accurately detect the pendulum’s slow reversal, but it looks to me like it’s almost ready to head back the other way. Maybe it wasn’t permanently lodged on the clinical side after all.

The reason is disillusionment. CPOE got sold, but not used. Clinical decision support systems haven’t yet yielded the expected results on clinical outcomes. Small-practice doctors have steered a wide berth around electronic medical records systems. RHIOs met the technical challenges, but not the business ones.

In the mean time, payments (or "reimbursements" for those too polite to say the word) have been stagnant or declining. Costs are up (including IT costs ratcheted up by all that clinical systems activity). No margin, no mission. Before you know it, customers will again be clamoring for those formerly unsexy systems that handle purchasing, collections, and contracting.

Wall Street and the private equity companies apparently see it coming. Indian firms are snapping up healthcare billing and collections companies. MedAssets and athenahealth are going public with an attractive value proposition: those who use their systems, unlike clinical systems, get to take home more money. Wal-Mart is putting its healthcare IT clout into RFID tracking, not patient care software.

That "equal but opposite" reaction was inevitable. Care redesign hasn’t paid off yet, so it’s time to go back to wringing inefficiencies out of the system. Everybody’s best hope for doing that will rest with IT systems, just like it did for outcomes improvement.

That’s not necessarily a bad thing. Once one fire has been brought under control, it’s time to turn the hoses on the other ones. Everyone gripes about healthcare costs even while providers swear they’re not making money, so something has to give.

The great thing about predicting a trend is that you can be vague on the timeline and you’ll eventually be right. So, here’s my prediction: it won’t be long before the industry will be buzzing about administrative systems again.