The Big Divide: Where are we now?

Thoughts on the Healthcare Roadmap

Chapter 1, Episode 2

The Big Divide:  Where are we now?

First, thanks to those who have sent me such encouraging notes after posting Episode 1 dealing with the Healthcare Roadmap.  This first chapter is intended as a high-level introduction, so I am pleased that you found this simple summary of recent legislation to be of value.

In this Episode 2, we move from simply summarizing recent legislation to consider the qualitative differences between the “Old World” of 2004 (or any time before the recent legislation) and 2016, the “Transition.”

In this video we compared the Old World to the Transition world by looking at a short set of characteristics.  These aren’t exhaustive, nor do they apply equally to every stakeholder.  Nonetheless, as I talk to providers, payers and patients, they present a pretty good summary of where we are.

We then looked at the Triple AIM, which has now become recognized as the Quadruple Aim.  This is a short-hand summary of key objectives that apply to healthcare broadly.  Developed initially by the Institute of Health Improvement led by Dr. Don Berwick, this short statement of objectives is an effective expression of the goals to which the healthcare industry aspires.

The key take-away is that we are still very early in the evolution along the healthcare roadmap.  While the case can be made that we have made some progress towards achieving the first three goals (improving the patient experience of healthcare, improving population health and lowering, or at least slowing the growth of, cost per capita), the jury is out whether we have improved the fourth objective, improving the clinician experience.  The case can be made that recent mandates, including technology requirements and even quality metrics, do more to hinder healthcare delivery than to help it.  Indeed, the best summary of that sentiment is expressed by the phrase “click-box medicine,” in which workflow and practice are constrained by the technology and measurement, not enhanced by it.  As I note in the video, this is more a reflection of the state of electronic health records and the early evolution of work flow to promote true care collaboration and patient engagement.  I believe that this is a temporary condition that will eventually be resolved as these technologies and protocols mature.

With this as the starting point, in the next episode we’ll next discuss what we can anticipate about the future state of healthcare.  What will the healthcare world look like in ten years?  After that, we’ll discuss barriers to adoption of new work flow and technology that must be overcome in order to achieve that future vision.  Finally, we’ll close out this first chapter by looking at a tool to evaluate an organization’s progress along the healthcare Roadmap.  Then we’ll move to the fun stuff:  Chapter Two:  Show Me the Money!



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