Cash for Computers

John Commins and Jim Molpus, for HealthLeaders Magazine , May 11, 2009
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Mac McClurkan, CIO at HealthEast Care System in St. Paul, says there is already an insufficient pool of healthcare technology professionals.

"There's not enough of them to go around today, and with the increased demand [through stimulus spending], I think that will be intensified."

McClurkan says he expects to see many customers trying to access finite resources in the vendor community. "There's only so many systems that can be sold and implemented within a given period of time. So I think supply and demand will shift somewhat," he adds.

Mark Leavitt, MD, chair of the Certification Commission for Healthcare Information Technology, says the new health IT workers will come from inside healthcare, from college students recognizing the job potential in health IT, and from IT people from other industries, such as finance, who have suddenly found themselves without a job. "Finance is undergoing a consolidation and a collapse, so maybe some IT people there that know networks and PCs can be used in health IT instead," he says. "There is a great job rescue in the making. You can't use them for the clinical stuff, but a network is a network and a PC is a PC, and you need a lot of that."

That's exactly wrong, says Scot Silverstein, MD, who teaches Healthcare Informatics and IT at Drexel University's College of Information Science and Technology. He says one big reason why HIT won't live up to its promise under an accelerated implementation is because all of the major companies designing health IT primarily have backgrounds in business computing systems, not healthcare systems. The end product, he says, is a system designed by people who don't know anything about healthcare, and used by clinicians who don't know anything about computers, both of which are distinct subspecialties of computing.

"Clinicians don't need an inventory system of data. They need something that supports their ability to think and do things rapidly and improvise and do things on the fly because that is the way medicine is," Silverstein says. "Other than the payment, medicine is not a transactional business. So you have people building business information systems masquerading as clinical information systems and you put them in front of doctors and the tools are wrong for the intended users."

John Commins and Kathryn Mackenzie<

Uncertainty Abounds

So healthcare executives have these political, technological, and financial factors to consider. Fine. But complicating all that is the matter of goalpost placement. Where are they and, once placed, will they be moved?

Beyond the question of whether health IT will actually work, the government says it will require providers to be "meaningful users" of health IT to receive enhanced Medicare/Medicaid reimbursements, but the government has yet to provide a definition of meaningful user. Nor has the government determined what standards will be used to certify health IT under the criteria laid out in the stimulus bill, or what entity will audit those standards.

That uncertainty certainly creates anxiety among hospitals and physicians thinking about sinking big bucks into health IT, when they may learn in a few months or years that they've bought a DVD in a world going Blu-ray.

Mark Leavitt, MD, chair of the Certification Commission for Healthcare Information Technology, the independent agency charged by the government with approving health IT systems, concedes that the federal government still has a lot of work left to provide a framework for health IT. But he says providers that attempt a good-faith effort to install health IT probably won't have problems meeting federal guidelines later.

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