Follow the Information

Why do we put up with this?

We know about at technology-enabled business models in corporations, social enterprises and government. We have seen the need for leadership at the top and collaboration across silos and boundaries. We talk about the need to get information flowing across these walls. And that's essentially what we are looking at here, except on a massive scale. We have a gaggle of players: doctors, hospitals, insurance companies, employers, government and researchers, all operating in an environment that just sort of happened.

This "system" is usually analyzed by following the money. The explosion in medical knowledge over that past half century and the creation of new diagnostic and treatment procedures and equipment have sent the costs of medical heavenward, and the game has been shifting those costs around.

Patients whose care is paid for by employers or the government have no reason to not take advantage of it. Employers reduce benefits and raise premiums or drop medical insurance coverage altogether. Insurance companies hold doctors responsible for the amount of care they dispense and dispute more and more claims. Hospitals send patients home earlier than ever. Doctors spend less time with patients and worry if they order too many tests, because the insurance company will ding them, or order too few tests, opening them up to lawsuits. Patients make endless calls to scream at insurance companies about denied claims. And on it goes.

Let's analyze the system from the perspective of information flows. Think about the model introduced earlier for corporations - the need for information to flow within the organization, to and from partners and from the external environment. Processes need to be established to enable collaboration. In the same way, a doctor needs information about a patient - current condition, medical history, information about the patient held by other doctors and institutions, and knowledge of the latest research and thinking about the condition affecting the patient.

The problem is that vital information is missing in one out of every seven primary care visits. Information is often unreliable - it's estimated that pharmacists make 150 million calls to doctors every year to clarify prescriptions; only about nine percent of U.S. doctors use an electronic system for prescriptions. What information is available must be transferred laboriously by paper; databases in hospitals and doctors' offices are often unable to talk to each other, because there are no data standards.

Creating all these silos of data is no small task: in some settings doctors and nurses spend as much time on paperwork as they do treating patients. Did you know that the 130,000 pages of Medicaid and Medicare rules and regulations are three times the size of the Internal Revenue code? Did you know that a Medicare patient arriving at the emergency room must sign eight different forms?

When all of this is resolved, and we think it will be eventually, the real innovation will not be the technology. It will be how the medical community rewires the way it works and collaborates. It's a people and organizational issue. We are accustomed today to seeing twice as many clerks as medical personnel in a doctor's office. That will change. There will be fewer visits to the doctor; information will be exchanged electronically. There will be fewer repeat tests. Doctors on rounds in a hospital will have everything they need to know in a small device hanging on their belts. Patients will have access to their medical records online, and so will the emergency room. But all this will require change, and change is not easy.