Remember when using language correctly while speaking and writing provided a common ground for understanding?  I write what I mean.  Nothing I ever wrote will be used as eleventh grade English Lit class assignment to ferret out my intent.  A few responded to the my discussion questioning if I felt involving business people in reform meant giving them carte blanche to mess in areas where they have no expertise.  I wouldn’t recommend that any more than I would recommend involving its reverse.

I am not a clinician or medical professional, don’t intent to be, don’t play one on TV.  I have not offered, nor will I offer my opinion on anything medical.  There will be no critiquing of who should be seen, what procedure should be performed, how to perform them better, or is entitled to what.  That’s all outside my pay grade.  If I cross that boundary, do us both a favor and take away my crayons.

That said; let met share what I think is being left out of the discussion about EHR and reform, a topic some treat as an unspoken side issue.  It’s almost as though this is the black sheep of reform, the part of the rug we want to sweep under the carpet—how’s that for mixing a metaphor?  There are those who think of healthcare as a business, those who begrudgingly think of it as a business, and those who never will.

Those at both extremes have contributed to healthcare’s present circumstances and an ill-managed rush to change.  Those in the business only camp, instead of making healthcare more effective have opted to make it more efficient, cutting costs by cutting jobs, and services.  The payors have added to the ineffectiveness by managing to the price of their stock instead of the public trust—these need not be mutually exclusive.

Effectiveness is all about quality, efficiency is all about speed.  Poor business leadership has helped some hospitals do a lot of ineffective things very quickly, but not well.  I’ve never met an executive who didn’t know how to cut costs—it doesn’t take a village to raise a cost slasher.  I, like you, have met very few who know how to increase revenues or increase quality.

Then there are those who will never see healthcare as a business, yet some of them hold senior business positions, positions which call upon expertise they do not have or do not find particularly necessary.  Just as business people shouldn’t perform open heart surgery, there are some better suited to medicine than to IT or P&Ls.  Curiously, those words are not mine; they were told to me by healthcare executives, some with MDs and PhDs.

The healthcare business is uniquely intertwined with the healthcare mission.  Should it be subservient?  That is a question better answered by the ethicists than by me.  I conclude that there are ways to make the business better that will make the mission.  That’s what I look to uncover.

Can EHR be used to improve healthcare?  It depends.  If properly planned and executed, yes.  If done simply in the belief that all things automated are better than those that are manual, no.

Think about a hospital you know well.  How many human resource departments does it have?  Registration?  Payroll?  IT?  What else is duplicated?  How many duplicate departments are required?  Can duplication be removed without simultaneously harming the business or clinical side?  If done correctly.

I think much can be done to improve the healthcare business without impeding the business of healthcare.  To me, that is the part of the mission with which reform should come to grips.