10 Years After...

There is a lot of content being generated about the 10th Anniversary of the IOM To Err is Human report back in December 1999. As I sit and listen (seriously, click the link and listen while you read the post!) to "I'd love to change the world" by Ten Years After (yes, I'm a child of the 1960s and 70s), I feel like the words ring home in so many ways the IOM probably didn't ever consider at this place in time... And I'm sure Alvin Lee wasn't thinking about healthcare reform when he wrote the classic lines:

"I'd love to change the world, but I don't know what to do. So, I'll leave it up to you."



"So, I'll leave it up to you..." The IOM wanted to change the world, but who is going to do it? Who is the "you?" It's Us!

Robert Wachter from UCSF just published a follow up report in Health Affairs where he gave us a B- on our efforts to solve the problems of health safety. As he notes on THCB, this is a minimal improvement from the last grade he gave us (C+) at the 5 year mark. The improvement in scores was due to increases in public reporting, improvements in safety enterprises within healthcare organizations and the establishment of "never events." Alternatively, healthcare IT has made "little progress... particularly when you contrast it with the breathtaking progress we’ve made in IT in virtually every other part of our personal and professional lives."

Why has healthcare IT had such a ho-hum effect on overall patient safety? Part of it is our expectations - IT viewed through the rose-tinted, round glasses of the Flower Power decade. A few weeks back, WSJs HealthBlog quoted one doctor saying that we have "magical thinking" (as in Magical Mystery Tour?) when it comes to health IT. According to him, our expectations that implementation of health IT will finally "save healthcare" is just plain wrong - and born out by studies. To be fair, targeted, judicious IT efforts can deliver exceptional results - when they are done right. But many IT projects are just to large to provide the focus needed to be successful. Another problem: the focus is on installing software, not delivering results.

This focus on results was another topic WSJ HealthBlog tackled this week. In this article, the incentives to reduce re-admissions were examined. I think everyone in healthcare would view re-admissions, especially shortly after discharge, as an indication of failure in some basic part of the process - a negative result. But the incentives for payment do not see it this way. Providers are paid for each admission. Reversing this incentive would provide impetus to focus on follow up calls, discharge counseling and preventative care outside the hospital.

"I'd love to change the world..." I think I have some ideas what to do

~charles