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Gopal K. Chopra, M.D. Headshot

The Plea for Better Health Care and the Health Tech Calling

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Now more than ever there is a clearly expressed sentiment from the public for change in health care, and not all of it spurred by the politicians' need for a platform. We are witnessing a barrage of pleas in the form of innovation, apps, and novel device use to address the fundamental breaks and gaps in the delivery of care.

The sentiment is universally identifiable but the stakeholders are diverse and makes for a cacophony of opinions, each with a complex and personalized service need.

The milieu is complex. We have the need for innovation but we are creating dissent toward technology by forcing compliance and further distancing the providers of care from their work. New technologies bring with them yet another administrative task, restriction of use or policed protocol to manage the care delivery team. From manifestos to information systems implementation, the suits ride in and make frame shift decisions with preconceived but unfounded view of the positive impact it will have on the practice of care or even the process of care. This driven focus on holding the provider accountable to system compliance without reference data is all a far cry from the espoused purposes of quality control.

When we look at the world of health care IT, we have seen some dramatic policies change how healthcare is now reviewed, not delivered. Many practices across specialties are now saying that they are either switching EMR or switching to light paperless record keeping and aborting the EMR notion because of the failed efficiency and relevance to empowered care. Those practices without EMRs are vindicated and believe they are economically better off with the imposed 1 percent reimbursement EMR non-compliance penalty from Medicare than installing a system that will reduce productivity, introduce new errors and simply not deliver on the promise of connected care for the patient. As a tool for market differentiation, the practice managers feel they are still better off with word of mouth marketing than technological differentiation. New tools such as social media and its complex integration into search engine optimization are foreign to the medical environment and leave many dismayed because they don't know or cant maintain the relevance of their practice to the larger audience. Larger institutions have dedicated a significant time and monetary budget to implement this well, but surrounding them is a very nascent ecosystem.

The great minds of business strategy seem to be vacillating between business process analogies and marketing hype to tout change. They seem oblivious of their own teachings that have helped industry explain market forces, decision processes of adoption, innovation disruption and change management.

The market forces in health care are conflicting when the demand for quality product delivered at a price that can be economically subsidized is left wanting because of supply constraints that are hampered by inventory mismanagement.

Adoption relies on choice and discerning buyers making free market decisions that breed best of class solutions that have lower impact implementation.

Innovation thus is not disruptive to its environment, as witnessed by the imposing and often broken IT user interfaces, but rather a disruption to the status of servicing an unmet need. Users seek to improve and become more efficient and if the user experience is complex and compromising as is being witnessed by the implementation of various meaningful use mandates we only compromise the richness and accuracy of the data, hence disabling more complex thought and care flow optimization for the future.

Information technology is negatively affecting productivity and the care delivery process. What happened to real quality improvement and change management process?

Health care is a multidisciplinary organism with various knowledge compartments that are not managed well and thus compromise its function. The primary goal of change management is to identify your knowledge assets and introduce process change to isolate and support them to excel, whether an ICU nurse or a neurosurgeon, their individuals organized in teams need to be aligned to care delivery. Alas, in the middle of the busy work day someone has to respond to the medical records alert so that the patient record can be sent to billing otherwise ones performance points are docked.

We looked to the innovators of the world and were greeted with garlands as they flocked to show us how they could change the world. But with an archaic and unmoving insurance and fee for service environment the investors of these fledgling companies guided them to conformance to current pay models, whether with insurance or willing self-insured employers morphing the innovation into a mouse trap that we clearly had prior insight, would not change care. Business case after business case clearly identifies models of subscription that are fads and trends and not sustainable and steered any hope for change to the various bland solutions we currently administer.

The purpose of technology should be to facilitate and is the guiding principle behind the company my physician wife and I started, PINGMD. Unobtrusive interfaces, relevant integration to the collaborative work environments of care and the level of simplicity that engages deeper interaction are the fabric of our design DNA at PINGMD. PINGMD is a secure collaborative care communication platform that is re-establishing the strong relationships that exist in healthcare between doctors, nurses, care providers and their colleagues and enabling better personalized and direct access to care advice for their patients. Our purpose is to enable doctors and care providers to network with each other and patients, delivering secure message capability to resolve the task lists to deliver better care, effectively and efficiently.

We live in a cloud era and it is apparent that our leadership, politicians and associations do too. So far from reality and without clarity of the disparity of safety and accountability in the flagship systems have decided are best for us needs better management and involvement of clinical quality managers and not implementation managers or budget managers. Task forces to manage overbilling with the very system forced upon us to seems to be the more vital function for cost control than a task force to see how this would effect the efficiency and effectiveness of care, but I guess that improves employment of yet more people to manage a broken delivery system and qualifies as meaningful use.

The conversation of care must be reignited, this time as a single voice from the care provider as advocate for the care delivery process and patient outcomes. I am talking about the new generation of data management that is critical to the delivery of care. We have ignored the basic facts that we have great technology, more enabled communication and a highly capable work force but combined they are working at a fraction of their potential. I hear the pleas of the masses for better healthcare and change. Here are my pleas to the constituents in my playing field:

  • Policy makers -- metrics and accountability of forced systems is a reflection on you not us. Enable us with data driven choice and we will measure ourselves.
  • Administrators -- multidisciplinary teams need to maximize the value of their knowledge assets and not dilute them, process change is a method to optimize the process.
  • Engineers -- science has rigor and quality requires rigor, software needs to learn before it teaches and if the interface doesn't work the data will suffer by virtue of design not its implementation.
  • Insurance companies -- reimbursement is a fee not a risk assessment; leave that to the licensing bodies.
  • Regulatory agencies -- don't confuse safety with advocacy -- clinical data takes time and specificity means just that so best practices need collaboration.
  • Techies -- curmudgeons are those of ill temperament when the darn thing doesn't work an experience I don't get with many an app I just download.
  • Technology and Information officers -- touting, "I can now read the doctor's writing", is not a defendable justification for a multimillion-dollar product implementation!
  • Colleagues -- vote for outcomes and effective care, we always have, so why drop the ball in the face of change?
  • Patient -- I know you spend 50+ hours a week searching health care issues and its OK for you to be upset that you cannot speak with your doctors and their care teams. We are upset too, so let's join forces on this one.
  • Colleagues -- the startups are an expression of need as they see the pains and inefficiencies of our system and I know that our operational constraints make it hard to jump on every idea, but we should be favorable to change and get to a better place, lock arms with them.

I believe that this environment of technology modifying our behavior and interaction with services is going to get us to a better place, but we need to unshackle from the current legacy, arcane solutions and byzantine management approaches and enable the embrace for change.