Thursday, July 30, 2009

Wisdom on the Health Train Express


Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.




What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”

(underlining, mine)

The analogy between the auto industry and health IT is obvious.

Will the Obama administration’s $20 billion push to flood the nation’s physician offices and hospitals with electronic medical records (EMRs) suffer a similar fate?

“Technology doesn’t change lives,” Riley said. “It’s the process around the technology that brings results.”

I think this is what doctors are talking about in their reticence to accept EMRs into their practices. What is good for the goose, is not necessarily good for the gander.  Small practices (group, or otherwise) are different administrative animals than large and even huge integrated health care systems.

An easily observed manifestation of this is what I call the 'walkaround"   Walk around a typical small group or solo practice and compare the square footage in a smaller practice  dedicated to clinical care space, and administrative space.  Where is the administrative space? In these large entities, those with the nicest offices with a 'view' are the nurse case managers, heads of departments, and executive administrators.  This is obvious when one tours a VA hospital, Army, Navy hospital and Kaiser Permanente. 

Are these administrators 'evil people"?  No, however the pecking order and corporate culture encourage this development of space allocation, especially since administrators control the purse strings.  I have even heard practice managers discourage allotting a comfortable 'thought room" because doctors don't see patients in their "personal office space".

More on this in my next post. I have a patient waiting and have to leave my 'personal space' (100 square feet).

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