Information Technology Cannot Heal

“In health care, as elsewhere, information is power: not only the power to heal, but also the power to improve quality, efficiency, reliability, safety, and value.” David Blumenthal MD

This stunning quote is another example of solutions that will "come from above." Such a perspective is quite the opposite from a focus on the top priority of the challenging labors at the local and individual level where health care and other needs are most complex.

Adding more and more to administrative cost is a major reason for higher health care costs. As noted in small practices, something about the small practice results in quality improvement. A greater emphasis upon local and individual would have to be considered high on the list of reasons why.

Experienced clinicians directly connected to their patients would consider that 
  • Bodies have the capacity to heal themselves.
  • Clinicians cannot heal but they can help the body to heal
  • Health information technology has little capacity for aiding a body in need of healing or helping to solve the lack of clinicians and team members needed to aid patients
Those less connected locally to individual patients and their situations might have limitations in understanding what may or may not work for "quality."

Global Fails Local But Local Focus Succeeds Globally - nations are only as good as what is happening for the half of the population that are most behind. Recovery of nutrition, education, child well being, and health areas involves local implementation. Global focus can be a distraction from needed local changes that could impact social determinants and situations and individuals.

Common Core and other global uses of information are not helping our nation with better education. One would have to consider that insider information has helped corporations to profit, but not individuals. Health information technology is quite limited despite countless billions in investments - investments that have rarely helped the local situations that must improve for health care to improve. 

There is a danger that use of any tool in medicine or in health care results in thinking that solutions can be provided by that tool – even though the tool is not capable.

Health information can, in some future way, be helpful in aiding people toward healing, but only in ways specific to the persons in need and through those who care for them. There are other priorities such as health access workforce and redesigns of health care spending.

The Commonwealth Fund has long provided assistance with needed health care redesign. 

“The Commonwealth Fund is a private U.S. foundation whose stated purpose is to "promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable" and the elderly.”

Will Commonwealth continue in this direction? Does such a high level of emphasis on health information technology help or hurt access? Access still suffers along with the providers where care is needed. Health information technology costs and requirements have in some ways made matters worse as noted in Preventing Rural Workforce By Design.

Elderly, poor, Medicare, Medicaid, Veteran, and others are more likely to be found in 2620 counties with lowest clinician concentrations where 40% of Americans are found along with higher proportions of the Americans in most need of care. Vulnerable populations and vulnerable practices and vulnerable hospitals need a much better design and much better understanding. More evidence of harm is being gathered and health information technology has contributed.

Awareness must be raised regarding:
  • Small practices that are 45% of the nation’s primary care, and the small/rural hospitals that also provide substantial care for the Americans most in need of care - Damn the Reality of Small Practices - Full Speed Ahead
  • Misuses of health information technology resulting in lesser funding support for small and rural providers - adverse formulas, penalties, pay for performance  Pounding Poverty Providers with Pay for Performance
  • The payment designs that irresponsibly and unethically pay less where care is needed – designs that fail to consider beneficence, do no harm, informed consent, and protection of vulnerable subjects
  • Designers that seem to have no comprehension of the grassroots health care needs of most Americans  Perverse Health Payment Dividing US
  • Designers that have allowed a serious three decades long failure in health access in payment and in training involving failures to adopt payment systems to facilitate health access and failures to establish health care training specific to populations in need of care
Health access recovery in this nation must reach a top priority level to even hope to begin to recover health access. Health access recovery must have the state and national designs to spend dollars specific to health access in locations in need of access while the dollars are also specific to the health access workforce delivering the care. Without this foundation, there is no hope of health access recovery. With this foundation in place, the practices and providers that serve most Americans left behind can embrace the “global” and local information specific to improvements in quality and access over the next decade – and perhaps health care costs after a few decades.

Designs must stop preventing health access or rural workforce. Rapid changes in technology and diversions of spending to health information technology purposes can hurt the delivery of care where needed. Preventing Rural Workforce By Design

Top down solutions commonly fail local populations in need and their caregivers. Health care designers and those who influence them must understand this.

Oregon: Good Design Gone Bad Via Software - Oregon and Oracle are going head to head over the failure of Oregon's Health Insurance Website - Regardless of the outcome, the people of Oregon have lost

Graham Center Small Practices

Of Leaders and Geeks - Blumenthal June 2014, Commonwealth Fund

Family Medicine Needs a New Beginning

Hotspotting Has Many Spots To Consider

Retail Clinic Recoil

Global Fails Local But Local Focus Succeeds Globally

What Veterans Need Is Family Practice

Domino Decline By Design

Declines in Health Care Delivery Despite Increases in Health Spending

Perverse Health Payment Dividing US

How To Resolve Health Access for 40 States Behind By Design

Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...

Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.


Popular posts from this blog

Training Cannot Overcome Deficits By Financial Design

Critique of Commonwealth Fund Report on Ensuring Equity