When I opened my outer screen door this morning to pick up the newspapers, it sailed right over them. Only seven or eight years ago – even in a recessionary climate – the papers would have been too thick with advertising pages to have fit underneath.
What does this have to do with electronic medical records, the subject of next week’s public war game we are running among the nation’s leading business schools? Everything. The ever thinning newspapers declare the inevitable march of information from the paper world to the virtual world. That is the same direction the medical establishment much take – perhaps kicking and screaming – over the next decade. The UK’s National Health Service has already embraced electronic medical records. The U.S., with a push from the President and agreement by Congress, will move in the same direction.
Inevitable does not mean painless or thoughtless.
Aside from needing to agree on both technical and medical standards- daunting enough…just look at the companies we are representing in the war game: Google, Kaiser, McKesson, AllScripts – all concerned parties must ask themselves how will government and commercial interests handle privacy and identify theft?
Just this morning, the Boston Globe reported that an administrator at the Massachusetts General Hospital lost 66 records on a commuter train on the way to work. This is just paper, you say. If these were electronic records, you can always retrieve them. Yes, but…
The bigger the system the greater the potential information loss. In 2007, someone from the Veterans’ Administration lost a hard drive that contained over one million health records. One million could easily become tens of millions of records as storage technology improves. Around that same time period, thieves stole credit card identification from over 40 million consumers who shopped over time at the TJX retail chain.
What is my point? We cannot hide from the inevitable. Technology is driving all information – not just healthcare information – into cyberspace. One of the greatest challenges the war game teams will encounter next week is to demonstrate that their technology does more than just work. It must also work smartly and be able to secure the information that hospitals and patients put into it.
In his February 24th address before Congress, President Obama threw down the gauntlet. “Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives…So let there be no doubt: health care reform cannot wait, it must not wait and it will not wait another year.” Again on March 5th at the first Healthcare Reform Forum the President made it clear, “…decision should be made based on evidence, data, and what works.”
On April 3, 2009, we intend to run a war game that will explore how various corporate interests hope to cash in on the billions of dollars this administration will throw at the problem.
Can the President’s daunting initiative succeed in truly making the healthcare system both safer and more efficient? Hillary Clinton and Ted Kennedy tried to reform healthcare in the 90’s by taking on insurance companies and managed care organizations, only to be beaten back by Congress. This administration is taking on an even broader agenda of moving US healthcare to a position of paying for what works through understanding what works best and for whom. In order to do so, the President proposes to unify and make useful for research as well as for care delivery all information collected from patients, insurance companies, and clinical encounters, including genomics. What makes this initiative so bold is the push to make all this information transparent while at the same time promising to protect the privacy of all Americans.
The companies whose current strategies and market positions we are going to test include Microsoft, McKesson, AllScripts, and Kaiser Permanente. Each of these four companies represent different camps. Each wants to capture a large part of the multi-billion dollar pie being placed on the table.
Microsoft, already at the heart of many corporations’ IT infrastructure, has partnered with Johnson & Johnson and the Mayo Clinic to launch its HealthVault product. Allscripts, a highly focused and relatively mature rival in this nascent market, has over 150,000 doctors and 700 hospitals using its technology. McKesson, while far from a household name, has become the nation’s largest healthcare company and one of the largest players in the electronic medical records market. Kaiser Permanente is the country’s largest non-profit healthcare system with 8.7 million members in eight regions; Kaiser also operates HealthConnect, the world’s largest civilian electronic health record, a milestone that places the organization well ahead of other hospital-based organizations.
No company is likely to go in with a winner-take-all approach. Witnesses to this emerging electronic medical records industry will continue to see lots cooperative and co-opetition agreements, all marching towards creating “the” standard, or the key resource. We are currently completing the briefing book the teams will use as they prep for the game. The business school students have begun to huddle. MIT, Columbia, Wharton, and last year’s winning school, Kellogg have begun to study the nuances of each rival, speeches and pronouncements made by each of the players.
Tune in over the next few weeks, as I begin to discuss some of the issues these business school teams will confront, the barriers they will encounter to achieve success, as well as the nature of the electronic medical records initiative – the brass ring at the end of the contest.