DEC 16, 2013 4:00pm ET

HIT Confidential: Pearls of Exaggeration


The HIT Confidential blog allows prominent health technology leaders to anonymously share ideas, exchange best practices, solicit tips, ask advice and get a few things off their chests. Want to contribute? Be honest, be concise, and e-mail



I hope you recognize that there is a “sand grain of truth” inside every one of these “pearls of exaggeration" ...

Physicians don’t like technology. I don’t know how many times I have heard that physicians don’t like technology as the reason they fail to adopt a new initiative. That is not the problem. Physicians don’t like bad technology that only burdens them with administrative functions. No physician crossed the Medical School stage to pick up their coder diploma. I once went to a physician’s office to talk with him about adopting a piece of technology after hearing from the technology department about his “Luddite" personality. When I arrived, I found him sitting at a bank of eight monitors tracking his million-dollar stock portfolio. It looked like the newsroom on election night.

20-30% of money in healthcare is wasted. I am not aware of a single dollar in healthcare that does not end up in a bank account. There is no big fire where the systems burn the pile of wasted money each weekend. Every single dollar is vacuumed from wallets or payers and ends up paying for someone’s salary or systems’ toys. Every pocket will defend its right to be fed like a momma bear defending her cubs.

Committees are the “Kevlar” for a physician leader. The most dangerous place for a CMIO is making decisions alone. Every CMIO should have at least two committees to make all the decisions that affect physicians. The more decisions you make alone, the longer your neck will be when the inevitable implementation axes start swinging at anything that moves.

Medicine is full of “silos.” Medicine is not full of silos, medicine is full of kingdoms that have moats, boiling oil, and archers on the walls. A silo just sits there holding grain. The kingdoms of medicine have been built over decades by people who enjoy the power they have consolidated and constantly scan the horizon for threats.

Every organization is dysfunctional.  I have been part of many different organizations, ranging from critical access hospitals to some of the top organizations that you would recognize and every single one is a mess once you get in the tent. They all have resistance to change, physicians fighting with non-physician leaders, and people just trying to survive to retirement without having to change.  Stop thinking that someone else has this figured out.

There is no perfect software.  Meaningful Use 1.0 is a disaster for making progress. It is medical Brownian movement mistaken for progress causing organizations and physicians to have adopted marginal software to grab the evaporating cash, but not advance the exchange of information. I believe about half of the office software vendors implemented for 1.0 will be gone by 2.0 is complete.

Software barely matters. I’ve heard it said that software is only 20% of the success of a project and I believe that is about right. Most of a project’s success is the organizational will to get it done. A “can-do” attitude and resource commitment can overcome almost any problem. A Lean project cannot make a Two-Sigma organization elite anymore than a marble lobby raises hospital quality. 



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