2012 in Review
It's the time of year that many writers reflect on the major events of the past 365 days. I'll let the journalists cover the impact of the election, the epidemic of senseless violence, and the scandals of infidelity.
To me, there were 5 major healthcare IT events in 2012 that we need to recognize and celebrate:
1. EHR adoption became unstoppable - In 2010, the Beth Israel Deaconess Physician's Organization changed its bylaws to require a certified EHR as a condition of practice. Even in 2010 this was controversial and we had long discussions about exceptions for specialists and grandfather clauses for early adopters of EHRs which lacked the interoperability we required. In 2012, any such discussion became moot. 90% of our entire community of affiliated clinicians have attested to meaningful use. As Beth Israel Deaconess expands its accountable care organization, one of the first questions asked by potential partners is the IT integration strategy. In every community I visit in the US, clinicians are speaking about their EHR experiences. Initial implementations were often challenging, but I've not found a clinician who wants to revert to a paper world.
2. Health Information Exchange became real - In Massachusetts and many other state states, communities are exchanging data for care coordination and population health. Unambiguous transport, content, and vocabulary standards have taken the guesswork out of health information exchanges. Although technical issues have been solved, there are remaining business sustainability issues for some HIEs, but several have found that stakeholders will pay for data sharing from the money saved through cost avoidance as new business processes are enabled.
3. Standards harmonization became a process instead of an emotional debate - Having been involved in standards making. implementation guide writing, and regulation formation for the past decade, I can say that 2012 was a year in which creating/choosing standards become a well defined public/private process without any of the religious wars of the past such as "my XML is better than your XML". Each time there was a question to be answered, experts came together using a common process and either produced a definitive answer or concluded that existing standards were not sufficiently mature for adoption, encouraging the marketplace to experiment with novel approaches. For example, Massachusetts designed a very simple SOAP-based query/response approach to provide directories.
4. Patient and family engagement went mainstream - In 1999 when Beth Israel Deaconess launched Patientsite, it was considered very controversial to provide patients view/access/download to electronic health records. In 2010 when we added the full text notes created by clinicians, the myths about straining the physician/patient relationship with too much transparency still persisted. In 2012, it is now part of the Beth Israel Deaconess medical staff bylaws that clinicians share all electronic data with patients.
5. Privacy and Security in healthcare began the journey to maturity - As I've written previously healthcare has traditionally under-invested in the processes, procedures, and documentation needed to create a mature security program. Just as strong enforcement by the Securities and Exchange Commission created a culture of compliance that led us to trust in the integrity of the stock market, so does strong enforcement of HIPAA motivate hospitals and professionals to create a culture of security. Every healthcare CIO I speak with confirms that 2012 was a year in which security projects became their top priority.
Of course there were other trends in 2012 - every vendor developed a cloud strategy, clinicians went increasingly mobile, and tablets became the new desktop. Meaningful Use Stage 2 gave us a roadmap for the work of the next year. ICD10 was delayed until October 1, 2014.
Overall, life as a CIO also changed.
As a CIO in 1998, I wrote code and architected web infrastructure. As a CIO in 2012, I focused on change management, governance, budgets, developing the next generation of IT leaders, and communication. Although I have changed in the past 15 years, the healthcare IT industry itself has matured and the nature of being a CIO in 2012 requires a skill set beyond mastery of technology. As we approach 2013, I will again strive to maintain my equanimity, empower my stakeholders to select those IT priorities which best meet their requirements, and avoid becoming the rate limiting step in any process. 2013 will be a year with many important projects and a new set of regulatory requirements, but in many ways I think 2013 will be more about getting projects done and less about managing the disruption of change. 2012 set the course and we're all headed to a great future. Now we just have to do the work that will get us there.
Happy New Year!