My Thanks to Healthcare IT Professionals ... Along with a Look Back and Forward

National Health IT Week got me thinking about my 30+ years in healthcare IT, including the 27 years I spent leading HIT at Intermountain Healthcare.  What a blessing it is to be able to look back on your career, in an industry you love, and feel a sense of honor, satisfaction, and gratitude. I’m humbled it has been so for me and, I hope, it has and will continue to be, for you.

In my case, I came directly out of college and joined the IBM medical industry in 1968. What a yeasty time to be in healthcare automation…what with the passage of Medicare and Medicaid only a few years earlier. Predictably, I cut my teeth on IBM SHAS (Shared Hospital Accounting System) and automation of clinical laboratories.

A few years later, my viewpoint changed from that of a vendor to that of a provider when joining the precursor hospital system in Salt Lake City, which four years later became Intermountain Health Care (IHC). While my viewpoint changed, my respect for automation’s contribution to the solution of cost, quality, and access challenges only expanded.

Frankly, in some ways, I have been a little disappointed in our collective progress over the past 45 years … many of our industry challenges still appear almost impregnable. On closer observation, however, I find that not to be true. Because of the complexity of the challenges our industry faces, solutions evolve in layered patterns. In the 60s and 70s, automated solutions focused largely on financial and administrative systems. In the 70s and 80s, order communications and results review, combined with clinical department systems and physician office systems took flight. Then came managed care solutions and advanced imaging offerings and more.

Without a doubt the last decade plus has seen the deployment of integrated patient record systems. We can debate why it’s taken so long and cost so much.  Clearly the rhythm associated with technology-based industry advances has been influenced by technology advances themselves, inconsistent policy and funding plans, and an enormous under-appreciation of the human and work process barriers (“culture eats strategy for lunch”), among other considerations. What can’t be debated are the expansive introduction of automation into nearly every health care work process and the introduction of system-wide EHRs, promising a foundational platform for integrating and harmonizing automation offerings.

Thanks to all of you who have worked so tirelessly in automating critical work processes, at all levels and in widely diverse areas of healthcare organizations. I firmly believe the elusive goal of positively impacting our cost, quality and access concerns is in sight…and it stands on the shoulders of the industry’s automation successes to date.

While CIO at IHC for more than two decades, I witnessed the automation of a remarkable number of systems and processes. In the 90s, I remember with pride, thinking we were on the verge of something really special, given the depth and breadth of operational systems that were feeding a clinically rich, decision-support architected EHR that had been implemented throughout our IDN (Integrated Delivery Network).

I was right … and I was wrong. We, in fact, did realize dramatic breakthroughs but not in the way I envisioned. It was not the integrated systems, but their exhaust … the breadth and depth of unbelievably rich, operations-based data that drove our breakthroughs. Realizing the need for a flexible, late-binding, enterprise-wide data warehouse fed by our operational systems and coupled with advanced analytical tools, yielded insights and, allowed us to harvest improvement knowledge. Sharing this knowledge system-wide with clinicians and management and imbedding this knowledge back into our operational systems, took us down a path of real, documented, cost, quality and access improvement.

The industry has been on a breathtakingly expensive and time consuming sprint for the past decade or so automating essential operational information systems. Capping this technology effort with a foundation-based data strategy — an enterprise data warehouse, robust analytics and a sound data governance plan — holds the promise of a rich harvest from decades of significant IT investment and untold professional effort.

My personal thanks to the many IT professionals and healthcare vendors and suppliers that have gotten the industry to this pivotal base camp. I firmly believe the peak is in sight!  My best as we individually and collectively work to complete the climb.

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