$19.2 billion for health information technology http://content.nejm.org/cgi/content/full/NEJMp0900665?query=TOC Part of $787 billion economic stimulus package American Recovery and Reinvestment Act of 2009 The Health Information Technology for Economic and Clinical Health Act or HITECH The origin and the dollars
Scope: EMR Other systems: Billing and payments; HR; Hospital operations: dietary; etc. Hospitals Doctors’ Offices Clinics Support Services, e.g. Labs HITECH EMR
Scope: EMR & PHR EMR – electronic medical records managed by source of the data, e.g., hospital, doctor, etc. PHR – personal health records managed by the patient/consumer using Google, Microsoft, etc. HITECH EMR Hospitals Doctors’ Offices Clinics Support Services, e.g. Labs Google/Microsoft PHR Pharmacy e.g., refills Medical Devices e.g. iPhone Support Services e.g. Labs Family, etc. access
Scope/Value/Quality A complete accurate record that is available now is far more valuable than one that is incomplete or has errors or is “off line” The value is in the network, the number of participants, and the quality of the data These are the basic lessons of the Internet
Status of Implementation The Wall Street Journal identified 10 types of EMR systems and assessed their implementation in hospitals: Highest: Laboratory Results 75% Lowest: Physician’s Notes & Clinical Guidelines:15% All others: 27% to 52% Full EMR: 1.5% of US hospitals * The survey did not address the question of whether or not these systems can be integrated into a common network without significant modification or replacement http://online.wsj.com/article_email/SB124104350516570503-lMyQjAxMDI5NDAxMTAwNDEzWj.html April 30, 2009 * There are about 5,000 hospitals of which about 3,000 have 100 beds or more
The white spaces of organizations occur on organization charts between internal departments, in contractual ambiguity and regulatory complexity.
They are places where functional misunderstandings occur, communication falters, roles change, priorities conflict, rewards are unclear, risks are unknown, and managers sometimes see threats to their careers that outweigh the opportunities.
We work in those white spaces to define problems so they can be solved, design solutions so they can be implemented, and structure implementation so it can be managed.