Rhapsody Health Solutions Team

Good News For People Who Love Bad News

EHRs are poorly designed.

Health Information Exchange organizations are not financially sustainable.

Patient portals are a poor substitute for real patient engagement.

Will Meaningful Use be a victim of future budget cuts?

Since you’re interested in health IT and what I like to call “the modernization of healthcare,” you’ve undoubtedly read articles that advance the above opinions or, at the very least, read headlines that state similarly worded phrases. Implementing new technologies and changing an entire business model is extremely difficult, no doubt, but I worry that the prevailing sense of negativity perpetuating these stereotypes may discourage organizations from taking action and making bold moves in their health IT environments that improve patient care.

By following the age-old journalism tenets of newsworthiness (which includes conflict, extremes or superlatives, scandal, incompetence, and hypocrisy), is our industry creating a thought bubble similar to what Nobel Prize-winning psychologist Daniel Kahneman describes in his concept of “What You See Is All There Is” (WYSIATI)? In a 2012  Q&A with the Monitor on Psychology, Kahneman offers this summary of WYSIATI:

“People are designed to tell the best story possible. So WYSIATI means that we use the information we have as if it is the only information. We don’t spend much time saying, ‘Well, there is much we don’t know.’ We make do with what we do know. And that concept is very central to the functioning of our mind.

“There is a very nice example of this, and it’s actually the thing that impressed Malcolm Gladwell when he wrote the book ‘Blink.’ We form an impression of people within less than a second of meeting them, in some cases. We decide whether they’re friendly, hostile or dominant, and whether we’re going to like them. And clearly, we form that impression with inadequate information, just based on their facial features or movements. This is WYSIATI—we don’t wait for more information, we form impressions on the basis of what is available to us.”

The health IT revolution isn’t something that is going to happen overnight, which makes it susceptible to false or incomplete impressions. Just last week at a press conference discussing the current state of health IT in the U.S., Farzad Mostashari said:

surely along this path there are many positives to report, right? are they hidden or ignored in vendor press releases? are they being closely guarded by health systems’ marketing departments who have a strange compulsion to make their organization appear to be all inclusive and impervious to outside experts? in my opinion: yes, absolutely. it’s also much easier to report on the struggles providers are encountering on this marathon because they are a reality for many, and the skeptics will never be satisfied.

regarding the current state of health it and health information exchange in the u.s., brian ahier broke the news on hl7standards on progress released in a robert wood johnson foundation report, “health information technology in the united states: better information systems for better care, 2013” and supporting analysis published in health affairs. as of 2012, ehr adoption in the u.s. increased to 72% from 51% in 2010. 

there’s also more progress to report from a global view in this graphic that was part of accenture’s “doctor’s survey: us country profile” that i shared in a recent #hitsm chat. the graphic visualizes the progress the u.s. has made in ehr adoption and hie utilization. 

the accenture survey sample size was seemingly large (3700 total, 500 physicians surveyed from each country except singapore) but in my opinion may not be a true representation given that there were 878,194 licensed physicians in the u.s. in 2012. regardless of deficiencies in study design, the advances made from 2011 to 2012 should be recognized and this graphic shows we lead all nations surveyed except for spain, which has a centralized health system with designated, regional ehr systems. they also face interoperability challenges similar to what we’re experiencing in the u.s. 

other key findings from the accenture study show:

“– u.s. doctors especially, are embracing the use of these technologies, despite the fact that many agree the use of hie, specifically, does not reduce organizational cost as anticipated.
– nevertheless, doctors state they think they have achieved some important hie benefits such as improved decision-making and the reduction of medical errors.”  

good news may not be on the list for what constitutes a newsworthy story, but health it often exists under a dark cloud, meaning that positive industry news qualifies for the categories “surprising” and, now with these reports, “timely and relevant.” 

criticism is important and a key catalyst to spark improvement—especially in technology innovation. it’s also important to recognize achievements to obtain a complete “big picture” that includes historical progress and appropriate context.  


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