The CIO's Role in Healthcare Economic Reform

First, I want to recommend a book--Nudge-- for everyone in health care, especially CIOs. There are several elegant themes in the book, but one of the most pertinent is: If you simply expose people to data about their behavior and within a relevant context, you can often times "nudge" them towards a desired new state of behavior, without the need for a complicated, onerous, process improvement campaign... which usually nudges people away, not towards, the desired behavior. For example, the authors write about a campaign in California in which a utility company exposed data to consumers about their energy consumption as compared to other consumers in their neighborhood, including the lowest energy consumer in the neighborhood. Over time, the entire neighborhood reduced its energy consumption, including the lowest consumer, thereby establishing a new and constantly improving benchmark. Awesome. There are ample opportunities for us to leverage our data in health care to nudge better behavior, even if we can't completely overhaul the entire system.

Second, let's assume a few things for the sake of discussion:

1. Economics and Quality: Health care quality of care in the U.S. will not change significantly unless the economic model of health care changes to one which financially rewards physicians and hospitals for patient health vs. patient volume.
2. CIO Influence: Health care CIOs don't alone have the influence to radically change the economic model of health care.
3. Costs are Verboten: Health care is the only service-based business in the U.S. in which the service is provided without any discussion of the scope of costs during the course of the business transaction between the service provider and the consumer. In other words, neither the physician nor the patient have a clue about the true costs of care to the overall system of health care. In fact, discussions of costs prior to treatment are avoided like the plague.

I wrote an article for last Winter's edition of the HIMSS Journal which outlines the things which we can do as CIOs to help nudge the economic model of health care towards something more sensible. If you can afford it, do the right thing and pay for a subscription and download it from HIMSS. It's available here:  Winter 2008 JHIM.  If you don't have access to HIMSS archives, there's an interview here: Sanders' interview, CIO role in healthcare economic reform.