Just Enough Technology Should Be Your Goal

You can never be too rich or too thin, but you can have too much technology.

Walking around the show floor of the HIMSS conference a couple of weeks ago, just as I started with HealthLeaders Media, I was reminded of that again and again. The technology on display at HIMSS was an impressive summary of all that's been done in the past 20 or so years to use IT to solve some of healthcare's problems.

But at booth after booth, I saw software that boggled my mind in its complexity. One theme I've heard repeatedly as I've come up to speed on the challenges of the meaningful use of healthcare IT is how software can't do it all. How antiquated workflow routines in the clinic and at the bedside get in the way of quality care. How people and politics are the stumbling blocks to breaking apart those antiquated workflows and reassembling them with cost efficiency and patient satisfaction in mind.

Perhaps the problem is that we sometimes innovate ourselves into a corner. Ever since 1981, when I started covering the breakthrough of personal computing for InfoWorld magazine, our society has innovated and innovated.

Billions of lines of code delighted us in their utility, or vexed us with their complexity. Information technology went from not mattering, to mattering, to not mattering again in the famous Nicholas Carr article (and later book) of 2003.

Software doesn't write itself. Jobs and everyone else had to buy or build a set of tools, painstakingly, over many years, to get to the point where the complex could be made simpler. An iPhone has more parts than we can imagine. But development tools built every piece of that software.

As health leaders, you understand that if you don't understand the technology, you must make sure you hire and trust someone who does.

The best of you are constantly figuring out where too much technology is slowing things down, and trying like heck to do something about it.

That's easier said than done. Once legacy systems get their hooks into your business processes, every upgrade feels like the weight of the world, and changing systems completely is so daunting that it's a rare event. Making disparate systems talk to each other is incredibly challenging.

The recent PwC US Health Research Institute report on how providers trail payers and pharma/life science companies on their ability to exchange data, to me is a reflection on several things. It says that providers sometimes have been sold systems that are so complex, the data can't pass between them easily.

Other providers have either been too cash-strapped or too skeptical to adopt those systems in the first place, so they're still perilously close to keeping records on paper.

Think back just a few years, when IT systems were still pretty fragile. There was no such thing as backup to the cloud. Now, the ThinkPad my new employer sent me automatically backs up my documents and other work to the cloud on a regular basis. Before such backup tech was available, I wouldn't dream of asking a small medical practice to rely upon a PC-based solution. More data has been lost to accident (or accidental deletion) than any virus or lost laptop could ever be blamed for.

Not that backup to the cloud is a panacea. We've got HIPAA and other compliance laws to worry about. Cloud security isn't a settled topic by a long shot.

But back to this notion of Just Enough Technology. You run hospitals. You're not in the data center business. And yet, you are, because security, privacy, and availability dictate it.

Last week in this space, Ed Prewitt talked about the need for innovation in HIT. I'm here to echo Ed's thoughts, but also to remind you of The Innovator's Dilemma. Simply stated, disruptive technology outpaces established technology. Let's go back to our cloud backup example. If backup to the cloud is simpler and cheaper than local backup, why not put all of IT in the cloud?

Obviously there are tradeoffs. Cloud services are less reliable; a recent Windows Azure outage illustrates that point. But over time, these services will become more reliable. Already, there are totally cloud-based EHRs on the market. In time, they may seriously disrupt healthcare, by making smaller hospitals more nimble at adjusting their tech than larger institutions weighed down by years of previous deployments.

One thing you've told HealthLeaders Media, in our just-released 2012 Industry Survey, is that technology vendors alone won't save the healthcare industry. That's right: vendors rank dead last, behind hospitals, government, physicians, patients, technology, health plans, or the 31% marked "other." Vendors got 0 percent of the votes. Writing a check is necessary but not sufficient for hospitals to accomplish their healthcare IT mission. Vendors reading this, you should be ranking better than that!

I have a lot more to say about health and technology, and I will. But I want this space to be a conversation between us. If I've said something to inspire or outrage you, let me know in the comments here, or follow me on Twitter at @scottmace. I look forward to the dialogue.