Articles, PSQH January 7, 2010

Raison d’Être

by Barry P Chaiken, MD

What is the purpose of health information technology? Why are we spending all these billions of dollars on this “thing” we struggle to understand, implement, and use? Is it achieving the goals of its purpose?

The French elaborated on the concept of “raison d’être,” suggesting that once the reason an object exists is defined, criteria to measure the object’s value can be developed and applied. Now that the Office of the National Coordinator for Health IT has finally released the definitions of “meaningful use,” it is worthwhile to step back and reexamine the reason health IT exists.

The raison d’être of health IT includes four key items: 1) enhance patient safety, 2) improve quality of care, 3) foster greater accessibility, and 4) facilitate a reduction in medical costs. In addition, all of these items must occur simultaneously and in cooperation with each other. There is no zero sum game in achieving these goals, as failure to advance one brings failure to all.

Considering the current state of healthcare delivery in the United States, the four aspects of raison d’être for health IT, as defined above, seem appropriate and timely. While our healthcare costs per capita are the highest in the world, we endure worse outcomes, poor accessibility to care, high rates of uninsured and under insured, and unacceptable levels of medical errors. Few can deny the poor value we obtain from the resources expended on care.

So how and when do reap these rewards of health IT? Those that embrace flexibility, creativity, and tenacity will be most successful.

Flexibility. Health IT is nothing more than a tool. It is how the person that wields that tool acts that delivers real value. We are at the stage where our understanding of the health IT tool is just beginning. Therefore, we must be flexible in how we use that tool, wielding it in different ways to discover how to achieve greater and greater value.

Creativity. It is not enough just to be flexible. Flexibility has value only when it is utilized by creativity, the development of new and innovative approaches to problems. Creativity is needed in the design of processes and workflows that utilize health IT tools in a flexible manner, allowing these new approaches to be tried, reworked, and reapplied. It allows for the evolution of the use of health IT.

Tenacity. Clinical care is complicated and uniquely personal. This latter characteristic separates the use of IT in the healthcare industry from its use in other markets. This personal, and therefore human, factor makes what is very complex even more so. The complexity requires a level of tenacity, “stick-to-it-iveness,” that can carry us through challenges, problems, and failures until we are able to get the technology, processes, and workflows blended synergistically together, delivering our expected benefits.

As we consider all that has occurred in the past year, including the raucous effort to reform healthcare, the $19+ billion earmarked for health IT, and the debate on meaningful use, we must remember our need to be flexible, creative, and tenacious. No single effort or event can make health IT valuable. Only through our dedicated work, application of our professionalism, and our keeping focused on the raison d’être can we achieve the benefits we seek from health IT.

Excerpts from: Raison d’Être. PSQH, January/February, 2010


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