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Thursday, March 02, 2006


Why IT Can't and Won't Fix American Healthcare

Going though my office mail today, the cover of the current issue of Business Integration Journal screams out: "Life Support For Healthcare! SOA To The Rescue!"

Uh huh. Next hype-ridden statement, please...

A lot of trees, ink, and electrons get expended in the US telling us as a profession that proper application of IT here, there, globally, best-practiced, ad nauseum will 'fix' the American healthcare system.

The current system isn't fixable, by IT or anyone/anything else, herewith are some important reasons why - Robert Samuelson's commentary in the Washington Post a few weeks back making a vital point why this won't happen (at least under present conditions):

Americans generally want their health-care system to do three things: (1) provide needed care to all people, regardless of income; (2) maintain our freedom to pick doctors and their freedom to recommend the best care for us; and (3) control costs. The trouble is that these laudable goals aren't compatible.

We can have any two of them, but not all three.

What Samuelson describes here we would call a mismatch of requirements - the goals that 'the business' wants in this case, while laudible, aren't compatible with each other, or in context to the problem being solved or the process under development. When we design IT systems to respond to situations like this, the systems become as flawed as the processes and decision-making being supported.

We have, as Samuelson puts it, quite a conundrum: IT can certainly be used (and to an extent, has been) in a number of contexts to reduce or control costs. But that won't matter much if the other two factors are still present because reducing process-related expense won't counteract the explosion in demand for all services paid for, of course, by other entities like the government or insurance companies.

I can't tell you how many times I look at the admin areas of my doctor and dentist's offices and see shelf-after-shelf of color-coded file folders and wonder what the cost-basis and savings would be of all of that paper were digitized. It probably could be and should, but in the end given the above three constraints, will it matter in terms of improving care and the access of all to it?

Until we get our house in order with respect to expectations, if we ever do, there are no silver bullets to 'fix' our healthcare problems, including IT. And claims in our trade and professional magazines to the contrary are the most dangerous forms of hype and illusion that I've come across.

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