Whether as individuals, businesses, orgovernment, we collectively spend greatsums on care delivery yet obtain rela-tively low value in return.While the U.S.spends close to 17% of GDP on health-care, a report published by the Califor-nia Healthcare Foundation in May 2007showed that we ranked last or next tolast on 9 of 10 measures of healthcaredelivery. On the measure of medicalerrors, we ranked last among six coun-tries with 34% of patients “receiving” amedical error (Figure 1). As for deathsdue to surgical or medical mishaps, theU.S. experienced about 75% moredeaths than the average OECD country(Figure 2). Only on the quality measure“Safe Care” did the U.S. receive a highranking (Davis et al., 2007).

Are We Insane?Don Berwick, MD, an internationalleader in healthcare quality improve-ment observed that “every system is per-fectly designed to get the results it gets.”Building on Dr. Berwick’s notion, otherexperts have defined insanity as doingthe same thing over and over again andexpecting different results.

Perhaps for some of us, deploymentof healthcare IT is our expression ofinsanity. Many organizations, led by

Patient Safety & Qual ity Healthcare � November/December 200710 w w w . p s q h . c o m

By Barry P. Chaiken, MD, MPH, FHIMSS

T E C H N O L O G Y A N D Q U A L I T Y

Revolutionary HIT:

Cure for Insanity

dedicated and intelligent professionals,successfully implement—as defined bytechnical specifications—a variety ofhealthcare information systems only todiscover that their process and out-comes measures change little. Unfortu-nately, without changing the underlyingprocesses and workflows that existedbefore the implementation of health-care IT, little change in those measuresshould be expected.

Time for a RevolutionRevolution is defined as a “drastic andfar-reaching change in ways of thinkingand behaving.” Our healthcare systemrequires a health information technolo-gy (HIT) revolution, a drastic change inthe way we deliver care by utilizing IT innew and innovative ways. Aggressivelydeploying IT, to replicate the processesand workflows that currently deliver ourpoor results on so many measures, onlyguarantees continued suboptimal andunacceptable outcomes.

Touted as a source of great efficiencyand effectiveness, information technolo-gy currently offers limited healthcareexamples of significant and document-ed gains. Considering the millions ofdollars spent on healthcare IT by orga-nizations around the country, theseresults are quite discouraging.

To best understand why our gainsfrom IT investments have not material-ized, let’s look to other industries asmodels. Across many industries thatdeployed IT, a lag period occurredwhere quality and costs savings did notappear. As frustrating as this periodwas, companies that continued to investin IT slowly began to experience thejumps in productivity and profit thatwere long expected. Each organizationreached a tipping point where process-es and workflow evolved to take advan-tage of the new IT tools to deliverunprecedented results.

To look at the benefit of IT onthese companies in isolation is tomiss the true lesson to be gainedfrom their experiences. Early on, thedeployment of IT was viewed as thesolution. Only after companies rec-ognized it to be just a tool, did theyformulate the real solutions basedupon revised processes and flow,which then provided much of thebenefits.

Focus on Three Key AreasRevolutionary HIT requires a focus onthree key areas: 1) processes and work-flows, 2) information technology tools,and 3) healthcare provider tasks, dutiesand responsibilities.

Solutions come from an in-depthunderstanding of tools, and creativethinking around what healthcare profes-sionals can do and how best to use theirindividual skill. Bringing togetherexperts in clinical medicine, informationtechnology, and process redesign createsan environment where the best process-es and workflows effectively leverage thenew HIT tools. Such diverse workinggroups allow meaningful knowledgetransfer and the development of solu-tions that transcend the expertise inher-ent in each silo of knowledge.

Valued solutions offer these profes-sionals HIT tools that leverage their

Figure 2. Deaths Due to Surgicalor Medical Mishaps per 100,000Population in 2004

Source: J. Cylus and G.F. Anderson, MultinationalComparisons of Health Systems Data, 2006 (NewYork: The Commonwealth Fund, Apr. 2007).

Figure 1. Medical, Medication, and Lab Errors Among SickerAdults, 2005

Source: Commonwealth Fund Hational Scorecardon U.S. Health System Performance, 2006; Data:Analysis of 2005 Commonwealth FundInternational Health Policy Survey of SickerAdults; Schoen et al. 2005a

PSQH0406_NovDec07-2 11/13/07 2:21 PM Page 10

11November/December 2007 � Patient Safety & Qual ity Healthcare

Davis, K., Schoen, C., Schoenbaum, S. C., Doty,

M.M., Holmgren, A. L., Kriss, J. L., & Shea, K.

K. (2007, May). Mirror, mirror on the wall: An

international update on the comparative

performance of American health care. The

Commonwealth Fund. Available at

www.commonwealthfund.org/publications/p

ublications_show.htm?doc_id=482678.

Chaiken, B. P. (2005). Path innovation:

Transcending automation. Patient Safety

and Quality Healthcare, 2(3), 46-47.

Chaiken, B. P. (2007). Patient flow: A powerful

tool that transforms care. Patient Safety and

Quality Healthcare, 4(3), 6-7.

unique skills, while organizing the pro-cesses and workflows to deliver a con-sistently high quality, safe, and efficienthealthcare outcome.

Can We Change?Inherent in revolutionary HIT is theneed for change; change in what profes-sionals do and how they do it. There-fore, effective change management tech-niques must be utilized to facilitate theacceptance of the new processes andworkflows, in addition to any newresponsibilities and duties.

Currently, patient delivery reliesupon an unreliable system of poorlyintegrated and highly variable health-care professionals. Revolutionary HITsolutions provide needed support toolsthat increase the reliability of thehuman components, while integratingthese components through effectiveprocesses and efficient workflows.

Revolutionary HIT fundamentallychanges what physicians, nurses, andother healthcare professionals do. Physi-cian activities become more challengingon a cognitive level as other routine taskssuch as drug dose recall,use of best prac-tice order sets, and drug-allergy checkingbecome automated.Physician expertise isassigned to more important tasks includ-ing solving difficult diagnostic problems,devising customized patient treatmentplans, and influencing patient adherenceto chronic disease care regimens.

Work for nurses and other health-care professionals changes dramaticallytoo. More tasks, formerly done byphysicians or healthcare specialists, arecompleted by these professionals guid-ed by intelligent processes and work-flows that include meaningful HIT.

Revolutionary HIT places the rightprofessional,with the right knowledge, inthe right process,utilizing the right work-flow to deliver the best evidence-basedcare to the patient. Care delivery isfocused on the patient and their needsrather than the requirements ofunchanged, ineffective workflows estab-lished before the dawn of informationtechnology.

For information technology to play avaluable role in reducing healthcare costs

while enhancing quality of care, it mustbe deployed in a revolutionary way thatcompletely reinvents how care is deliv-ered, professionals provide the care, andtechnology is leveraged throughout caredelivery. Without such a revolution, thebillions of dollars currently being invest-ed in healthcare IT will have little posi-tive impact on our health. �PSQH

Barry Chaiken has more than 20 years ofexperience in medical research,epidemiology, clinical informationtechnology, and patient safety. As founderof his own company, he has worked onquality improvement studies and clinicalinvestigations for the National Institutes ofHealth, Framingham Heart Study, andBoston University Medical School. Chaikenis board certified in general preventivemedicine and public health and is a Fellowand Board Member of HIMSS. He is theassociate chief medical officer ofBearingPoint, Inc., adjunct assistantprofessor in the Department of PublicHealth and Family Medicine at TuftsUniversity School of Medicine, and serves

on the Editorial Advisory Board for PatientSafety and Quality Healthcare. He may becontacted at bchaiken@docsnetwork.com.

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