Mary Logan: Clinton’s Provocative Challenge to Healthcare

On Jan. 14, I had the privilege of hearing former President Clinton speak at the Masimo Foundation’s Patient Safety Science & Technology Summit in Laguna Niguel, California. Clinton challenged each member of the audience to make a written commitment to help reduce the 200,000 annual preventable deaths in healthcare. He nudged industry to open up the architecture of technology in order to maximize the ability of technology to be integrated. A number of industry players signed a pledge to do just that.

Clinton believes we are overwhelmed—across all sectors in our country—by complexity because this solution is tacked onto that solution, and pretty soon everything has a constituency for why things have to stay the way they are. He believes that healthcare is an “encrusted system because we haven’t made a commitment to a process of continuous improvement that requires our healthcare system to make widespread reforms.” His words ring true when thinking about a lot of issues outside of healthcare as well, from mass transportation to gun control.

While in California, I spent a day with staff at Kaiser Permanente. Clinton’s speech was the voice in my head as I learned about their big initiatives and challenges. Medical device integration is overwhelming. Kaiser Permanente has more than 300,000 medical devices, ranging from simple scales to complex imaging equipment. Using the scale as an example, implementation of “meaningful use” includes the requirement that patient weight be entered into the electronic health record (EHR). A health system like Kaiser Permanente owns thousands of patient scales. They are not interoperable, which leaves Kaiser Permanente with two basic options: 1) manually enter weight into the EHR (which would ring bells in a Lean or Six Sigma process), or 2) buy new scales, smart beds that weigh patients, or some other technology that introduces automation into the process. Kaiser Permanente has opted for the first choice.

Not all of a huge health system’s 300,000 devices need to be able to integrate with the EHR, but a substantial portion of them do. Pumps, monitors, and ventilators would certainly be near the top of the most lists. I would never have thought of scales being on this list until I met with Kaiser Permanente’s Clinical Technology team.

Clinton is right about the healthcare infrastructure being a compilation of solutions tacked onto solutions that are now unsustainable. Healthcare delivery organizations tend to be the focus of attention because they are the ones who have to explain the 200,000 annual preventable deaths. But industry, federal and state regulators Congress, the payer community, and patients contribute significantly to the solutions being tacked onto solutions.

Going back to that scale example, a thoughtful decision was made at high levels in our government that patient weight should be an early mandate under meaningful use, a solution tacked onto the decision that we ought to have an EHR. That solution results in a host of other disparate, disconnected, tacked-on solutions. EHR vendors (on their own and in different ways) focus on making sure their products have a mechanism for entering patient weight into the record. Device manufacturers focus on how they can build in a “scale” as a new feature to their products and then how to get that through the FDA’s complex regulatory process. Middleware vendors focus on their slice. The Centers for Medicare & Medicaid Services tacks on some new obligation about patient weight tied to payment (and the other payers follow). Hospital CFOs look at the financing for the new scales and integration needs. Healthcare technology management professionals and their facilities and IT colleagues focus on the hospital’s complex and usually aging infrastructure. And so on. It’s how we all naturally manage complexity and the challenges of a competitive marketplace with scarce resources.

Clinton’s other key message was that the most successful organizations in the 21st century will be the ones that collaborate in networks. He didn’t mean IT networks – he meant communities. His point was that our world is so interdependent that we can no longer be successful, as organizations or countries, unless we share openly and learn continuously together. He said that “networks that generate cooperation will dominate the world in the 21st century.” Imagine the power of a network of healthcare delivery organizations, clinicians, payers, regulators, industry, patients, and independent subject experts who collaborate on how best to reduce the 200,000 preventable deaths in healthcare.

Clinton’s words energized 300 people to make a personal commitment on that front. Out in the trenches, millions of technology-oriented professionals in healthcare also are energized and hopeful about making a difference, whether they are working in industry, academia, government, or a healthcare delivery organization. Let’s do it together, not as single disciplines or industries or regulators, but as a community, a network of people who care about the same thing and have something important to contribute to the decisions.

Mary Logan

AAMI President

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