"Houston, Tranquility Base here. The Eagle has landed."
Neil A. Armstrong, Apollo 11, July 20, 1969
With these two sentences, delivered in an utterly unforgettably straightforward but sublime manner, a decade's worth of scientific research and development, fits and starts, successes and failures, wrapped in a vision and "mission statement" we have not since seen the likes of which, we reached beyond our planet and
landed two men on the moon. Extraordinary. I was a little kid back in 1969 and can remember quite vividly that summer afternoon, watching our family's black and white television, my eyes glued to the grainy images being sent back from the lunar surface. When the "most trusted man in America," the late
Walter Cronkite, uttered, "oh boy, oh boy," as the landing module touched down on the
Sea of Tranquility, I can now imagine that many Americans, if not most of the world, thought, "We can do anything!"
[caption id="" align="alignright" width="304" caption="Neil Armstrong descending the ladder on the lunar module. Polaroid image of slow scan television monitor at Goldstone Station. Nasa image S69-42583. 20 July 1969"]
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Forty years later we celebrate that great achievement but one must wonder and question how far we've actually come since that historic moment. Have we made a bold declaration like the one
President Kennedy made at the beginning of his presidency when he said we would land a man on the moon before the end of that decade? Have the last forty-plus years not lent themselves to having us dream in such a grand manner? Of course not. Perhaps straightening out the health care mess is not as eye-catching or dynamic as space exploration but it is most certainly worthy of an unparalleled effort, energy and resources.
In my previous two postings, I examined the current state of health information technology (HIT) by breaking down the numbers, recent legislation and the commitment that will be required to transform this initiative into an actionable and sustainable operational reality. From a technology perspective, we can perhaps frame this matter by developing it from a Lean IT perspective.
One of the many great challenges facing adoption of HIT on a recurring and operational basis is the cost associated with designing, developing and implementing the technology that will support the mandates and requirements under the
HITECH Act.
While the federal government has allocated close to $20 billion to help health care providers upgrade their technology infrastructure, it may not be enough to fully galvanize and launch the multitude of resources required to get momentum moving in the right direction to efficiently implement and sustain this effort. Adopting a Lean IT framework will focus practitioner, patient, government and IT resources on designing strategies and operations that yield tangible, cost-effective results. How can this be done in a manner that meets the recently released
final definition of meaningful use adopted by the Office of the National Coordinator Health Information Technology Policy Committee (ONCHIT), as well as satisfying the regulatory certification requirements for electronic health records (EHR)?
The following table illustrates the pitfalls that can be encountered and must be avoided to help focus efficient solution design while mitigating the aggravations and waste that can potentially develop as the result of a complex and costly undertaking. While far from being a comprehensive approach to this issue, the table demonstrates that Lean IT principles must be incorporated into the overall design and implementation solution:
White Paper: Enterprise IT Management Strategies
Lean IT: "Waste Not, Want Not" "“ Strategies to Reduce Eight Elements of Waste in IT "“ November 2008
As discussed in the previous two posts, there are significant doubts within the provider community that implementing the policy directives under HITECH can be reasonably achieved within the timeframe mandated by ONCHIT. Adapting the eight elements above into the strategic discussion will aid the effort immeasurably and help focus resources more effectively.
In testimony given before the Senate Committee on Finance, Richard Hellestad of the RAND Corporation said that by adopting HIT:
"[d]uring the 15-year adoption period, the cumulative net savings would be about $510 billion or approximately $34 billion per year. To put these potential savings in perspective, $80 billion is 4 percent of the annual $2 trillion cost of health care in the United States."
HITECH is now law and ONCHIT has moved forward with a comprehensive meaningful use matrix. We now need to form a working group, not a committee, a working group that can marshal resources, initiate design of an interoperable and open-architecture infrastructure, mitigate project inefficiencies, energize the federal government and the American citizenry and build a health care system that reflects and befits a great and prosperous nation such as the United States.
President Kennedy's
speech before Congress in 1961 rings true today for the effort that will be required to create a successful health care program: "[T]his decision demands a major national commitment of scientific and technical manpower, material and facilities, and the possibility of their diversion from other important activities where they are already thinly spread. It means a degree of dedication, organization and discipline which have not always characterized our research and development efforts."