It’s all about the nodes, you “node-nothings!”

by Bradley Miller on March 23, 2009

For a while now I’ve been keeping an eye on the whole healthcare IT thing and have found just an incredible number of errors in the way we (as a country) approach the use of healthcare IT in our system.  I’ve published academic articles and a white paper on the subject of health information exchange, detailing one of the best cautionary tales for this time of uber-stimulus potential.

There’s lots of talk in publications like the Wall Street Journal that doubt the value of electronic health records/IT in practice, while there’s tons of governmental and industry press that tries to sell healthcare IT, it’s hard to tell who’s telling the truth.  And, if you’re a newbie to healthcare IT, John Halamka, one of the more rational leaders of the effort has a good blog and a great post that details the basic terminology. 

One of the lessons I learned through my research time at UCSF is to really dive in and check where publications proclaiming the value of healthcare IT come from – most articles cite a source they believe to be credible.  But, ultimately, if you trace those citations back, even the best sources of “data” on healthcare IT value are based on experts opinions. These “facts” have gained validity over time through being unintentionally “laundered” through citations in publications.  While some of these estimates and opinions are the best that we have, that doesn’t mean they’re accurate – both sides of the argument are using “proof” of dubious origination.

I have to admit, I’m burned out on the healthcare IT argument, but what does intrigue me about it is the business case around healthcare IT and the mistakes I think people are making with regards to finding a value-based argument for healthcare IT adoption.  Most of the public expects to never again fill out forms in doctor’s offices or tell an emergency room doc their history, and interestingly enough to me is that is enough for people to back hundreds of millions to billions worth of healthcare IT investment.  Guess what – you’re still going to have to do those forms.  Sorry to break the bad news – those forms are more of a CYA for docs in this overly litigious medical profession. Until that changes, you’re still going to have to fill out those forms.

The real value comes in as more and more docs and hospitals adopt healthcare IT – it’s the same value proposition as seen in the internet – it’s all about the number of nodes on a network that give it value.  Metcalfe’s argument, while more of a metaphor than a fact is a good place to start regarding the argument for widespread healthcare adoption.  Therefore, the first step in healthcare adoption needs to be the actual adoption of healthcare IT.  This has less to do with preventing errors or creating other efficiencies through IT adoption, rather it’s about digitizing and therefore “net-enabling” healthcare information broadly.  Which leads then to the second step – networking all that information in a meaningful manner.  It’s not until that step that the real, significant savings realized by healthcare IT adoption.

Here’s the rub – it’ll cost tens of billions of dollars to properly digitize a physicians’ practice or a hospital’s infrastructure.  That investment comes in the first wave of healthcare IT adoption when the ROI for the investment is low.  Healthcare IT adoption has been slow over the years, so it’s not going to speed up fast enough to really get to that second step of networking the data while the argument and passion for healthcare IT adoption is still high.  We need a solid plan now that understands this paradox in healthcare IT adoption and that looks toward long term success and makes the necessary funds available to ensure long-term success.  Otherwise, we’ll find ourselves creating a patchy system that is optimized for no-one and even more inertia that prevents true healthcare IT adoption.

Once we get to the point where we have the nodes on the network and information flows more freely, the ROI will become very apparent and innovations that we cannot visualize or conceive of today will become reality.  I hope we can get to that point.  Until then, just remember Metcalfe’s law of nodes as a guiding principle – I think an argument rooted in that tradition will help drive the necessary adoption.

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