Trajectory not Position

johnhalamka-headBy John Halamka, MD
Twitter: @jhalamka

In my various state, federal, and international roles I interact with a large number of policy makers from the executive and legislative branches of government. I testify to them, write policy papers, and call their support staff frequently.

At the moment in our society, there tends to be a general proclivity to be a criticizer rather than a doer, to tear down rather than build up, and to have hearings instead of taking individual action.

Everyone talks about what has not been done instead of examining the progress made.

A great deal of leadership time is spent defending the actions of the past, making promises for the future and filling the present with powerpoint instead of programming.

How do we break this cycle of negativity?

My view is that we must believe in incremental progress, communicate broadly, and focus on our trajectory not our position.

What do I mean?

Ten years ago when I chaired the Health Information Technology Standards Panel (HITSP), the debate focused on such topics as:

  • Is your XML better than my XML? (CCD versus CCR)
  • Is your HL7 2.x implementation guide better than mine?
  • Should LOINC coding of labs be required?
  • Can clinicians code problem lists using SNOMED-CT?
  • Are electronic public health submissions even possible?

In 2015, none of these items are debated. The dialog has shifted beyond controlled vocabularies to such topics as building trust fabrics across organizations, refining transition of care standards and embracing new architectures based on FHIR/OAuth/REST.

John Kotter taught us that all change requires a sense of urgency. I agree that there is an urgency to improve healthcare IT usability, workflow, and functionality.

However, there is no need to panic. We are in the biplane era of healthcare IT. Flying cars are better than biplanes but that does not imply we can widely deploy flying cars without inventing jet aircraft first. There are logical steps from our current state to our future state.

When I testify, I listen intently to questions and commentary. Often there is limited domain understanding of the nature of healthcare data, existing regulatory requirements, and clinical workflow. Rarely is technology the rate limiting step to innovation – the challenges are policy, psychology, and culture.

At age 53, my personal medical data is electronic. That was not true when I was 43.

At age 22, my daughter has never encountered a paper based record as an adult. She has always had access to 100% of her healthcare data on her iPhone. That was certainly not the case for me.

Since 1996, our ability to respect patient privacy preferences has improved immensely. See this twenty year review of HIPAA that illustrates how far we’ve come.

Some people call me overly optimistic. I tell people I am even tempered and predictable. I will neither over promise future progress nor use hyperbole to over simplify the complexity of the process issues involved in IT transformation.

I look at the experience of three generations of my family. The trajectory of IT over the past 10 years has been overwhelmingly positive. The next 10 years will continue to improve data liquidity, patient access, and usability.

Let’s all be doers. Our position will be imperfect because there will always be room for improvement. However, looking back after years of effort I can say that our trajectory vanquished many IT dragons along the way.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.