Managing healthcare’s information overload

With the continuing maturation of electronic medical records and telemedicine, the worlds of health care and information technology are now coming together at warp speed to create an aligned, integrated galaxy unlike any other in the universe of high-tech businesses, writes Michael Dowling.

Information can be a powerful tool when it comes to diagnosing and treating a patient’s condition. But in the seemingly simple words of Albert Einstein, “Information is not knowledge.”

Michael Dowling
Michael Dowling

It is an important distinction. As English clergyman William Pollard said decades before the invention of personal computers, “Unless it is organized, processed and available to the right people in a format for decision making, information is a burden, not a benefit.”

And when it comes to managing health care information in 2012, truer words have never been spoken.

While sophisticated electronic health record capabilities hold great promise for improving patient care, it is becoming increasingly clear that our ability to collect data is far surpassing our ability to absorb and understand it. In the not-too-distant future, health care organizations may be drowning in the seemingly endless volume of data that will give them the capacity to deliver the highest level of care to patients.

For decades, few other industries have been able to match the technological advancements made in health care. Tour a major teaching hospital these days and you’ll find ultra-high-field strength magnetic resonance imaging (MRI) and 128-slice computed tomography (CT) systems that can diagnose a slew of human ailments. To treat them, you’ll find countless gadgets, drugs and therapies ranging from robotic surgical devices, proton-beam radiation therapy, transcatheter heart valve implants and personalized therapeutic vaccines for cancer.

While sophisticated electronic health record capabilities hold great promise for improving patient care, it is becoming increasingly clear that our ability to collect data is far surpassing our ability to absorb and understand it.

These highly developed technologies have significantly advanced our ability to do wondrous things in detecting and curing diseases that have been killing us for decades. Consider, for instance, that the average life span of a baby born in 2009 was 78.9 in Ireland and 78.3 in the US. By comparison, average life expectancy in 1950 was 66.9 in Ireland and 68.9 in the US.

With the continuing maturation of electronic medical records and telemedicine, the worlds of health care and information technology are now coming together at warp speed to create an aligned, integrated galaxy unlike any other in the universe of high-tech businesses. Yet, for all of the extraordinary headway we’ve made, health care has lagged behind other industries in the technology that MANAGES knowledge, communication and information.  As a result, we run the risk of data overload.

As the chief executive officer of a $6.5 billion health care network in New York that includes 15 hospitals and more than 200 outpatient facilities, I have been a strong proponent of IT investment. Two years ago, I authorized the expenditure of up to $400 million to integrate an electronic medical records system in all of our inpatient and outpatient settings, including the offices of not only our 2,200 full-time physicians but up to 7,000 community-based doctors.

Even for a large health care system, $400 million is a huge expense, considering there is no short-term return on investment on electronic health records. And as difficult as it may be for some health care organizations to find the money, the reasons for investing are obvious: enhancing quality, managing patient care, monitoring and influencing population health, and reducing cost growth.  Those collective goals are core pieces of the US health reform law enacted in 2010, but from where I sit in the C-suite of one of the largest hospital networks in the US, they are unachievable if information cannot be shared, tracked, accessed and used in a practical way.

Two years ago, I authorized the expenditure of up to $400 million to integrate an electronic medical records system in all of our inpatient and outpatient settings, including the offices of not only our 2,200 full-time physicians but up to 7,000 community-based doctors.

All those in the business of delivering health care recognize that medicine is both science and art. Not everything fits neatly into statistical and computer models. Sometimes, we go for years using the same drugs, techniques and approaches to treat patients for certain diseases, only to find out later that we were doing it all wrong.

Having access to the right information enables us to see the error of our ways, but only if we’re able to figure out what information we should be looking for. In this brave new world of health care delivery, hospitals and other providers will need to invest in the talent and resources to analyze reams of medical data, understand what’s important and what’s not, and convert it into information that can be used by front-line clinicians who are diagnosing and treating patients.

It’s not going to be easy. Bringing the worlds of IT and health care delivery together is much more that than a technical challenge – it requires major cultural changes in how health care practitioners operate and function, major investments in hiring people with the right skills, ongoing training and structural transformation of how we deliver care, and how we look at new and more efficient ways of interpreting all of the information that is available to us.

Just think of the diversity of the health care workforce and the varying levels of educational backgrounds and skills held by individuals in countless job categories. Imagine the amount of training and retraining it will take to help them understand and make intelligent use of all of the new data being generated.

To succeed, we’ll need to be both high-tech and high-touch. The marvels of medical technology that promise to enrich the quality of our lives even further cannot take precedence over the human interactions between patients and caregivers. On the contrary, the days when physicians made nearly all treatment decisions based largely on their own clinical experience and data from various medical tests are drawing to a close.

In the new “patient-centered” model being embraced by health care providers, patients are becoming active participants in their own care. Rather than taking the same approach with all patients suffering from the same disease, health care providers will need to provide services that focus on individual needs and preferences.

So in addition to getting our arms around how we manage the mind-numbing volume of medical knowledge, communication and information, transforming our model of care also requires health care providers to make dramatic cultural and organizational changes.

Those are two enormous – yet exciting – challenges that will require health care industry leaders to forget how we’ve done things in the past. We’re creating a new future for health care consumers, not because we are mandated to, but because we know it’s the right thing to do. It’s our obligation and responsibility to identify and implement solutions, as difficult as they might.

As the great management consultant Peter Drucker wrote, “Everybody has accepted by now that change is unavoidable. But that still implies that change is like death and taxes — it should be postponed as long as possible and no change would be vastly preferable. But in a period of upheaval, such as the one we are living in, change is the norm.”

Information is not the key to success.  The knowledge of what to do with that information is.

Michael J. Dowling, who is President & CEO, North Shore-LIJ Health System, New York, USA, was recently awarded the CEO IT Achievement Award 2011 by the Health Information Management Systems Society (HIMSS).
The North Shore-LIJ Health System is the largest integrated healthcare system in New York State with total revenue of more than $5.5 billion. It consists of 15 hospitals, 17 long-term care facilities, three trauma centres, five home health agencies, and dozens of outpatient and ambulatory facilities throughout the New York metropolitan area. It is the nation’s second-largest, non-profit secular health system with more than 5,600 beds and a total workforce of more than 42,000 employees.
Mr. Dowling is also Chairman of the National Center for Healthcare Leadership (NCHL) and the Chairman of the North American Board of the Smurfit School of Business at University College, Dublin, Ireland. He is also Past Chairman of the Greater New York Hospital Association, the Healthcare Association of New York State and the League of Voluntary Hospitals of New York. He serves on numerous other boards, including the Institute for Healthcare Improvement and the Holocaust Center of Nassau County.
Michael Dowling grew up in Limerick. He earned his undergraduate degree from University College Cork (UCC) and his Master’s Degree from Fordham University. He also has honorary doctorates from Hofstra University and Dowling College.