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Blurred Lines, Complex Worlds

Years ago, Sports Illustrated ran a cover story on a star Chicago Bears linebacker. It was called "The Complex World of Mike Singletary," and showed a line diagram of the various maneuvers that Singletary considered on a given play.

I often think of that cover headline, inserting my source's name into that "complex world" slug. Earlier this year at a software user group meeting, I talked to the chief information officer of a well-known academic medical center. My first question was really just an effort to break the ice: "How many hospitals are in your system?" But I forgot the "complex world" principle. The CIO launched into a five-minute description of the multiple hospitals within the health system and the various ownership and governance relationships. To oversimplify, some of the hospitals were owned, the others were "affiliated." But that label does not do justice to the tangled nature of the hospitals' structure and leadership. Throw in a health insurance plan, and you have a Rube Goldberg machine. After a while, the CIO just stopped and sighed, "Well, it's complicated."

Our exchange speaks to one of the key reasons that adopting computer technology in the healthcare setting is so difficult. It is the square peg, round hole scenario on steroids. This particular CIO said the institutional complexity came to the forefront when the health system enacted its data-sharing privacy agreements under the Health Insurance Portability and Accountability Act of 1996. Figuring out who the "business associates" were was exceedingly difficult, the CIO said. So if you can't easily figure out who has the legitimate need to view which record, how in the world can you ever hope to use computer technology to facilitate the transaction?

Technology can compel the modern health system to revisit its org chart, however convoluted. In the case of this academic medical center, the CIO observed that the line between IT and biomedicine was blurring, because the hospital wants to feed data from its devices into its electronic medical record system. In years past, the IT department had little oversight on biomedical devices. But now that the data coming from these devices is moving into the EMR, that is sure to change.

Maybe the complex world of healthcare can be simplified after all.

-Gary Baldwin

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