FOREWORD

Every year, I travel a few hundred thousand miles helping governments craft healthcare IT strategy. The culture in each country is different but the problems are the same all over the world. This book is an invaluable reference for understanding what has come before and what trends are likely to shape the future.

The authors are a who’s who of the advisors and consultants who shaped thousands of pages of federal regulations across the past two U.S. presidential administrations. As the chair of the Bush-era Healthcare Information Technology Standards Panel and the co-chair of the Obama-era Healthcare Information Technology Standards Committee, I worked side by side with these authors and I can say with confidence that they have an inside view of the “sausage being made.”

Part I of this book covers healthcare information technology in the United States, but the concepts it relates from the past two decades of policy apply globally. The United States spends 17 percent of its gross domestic product on healthcare and yet does not lead the world in quality, safety, or efficiency. The United States must move from a fee-for-service reimbursement to value-based purchasing—paying for outcomes and quality—if it is to bend the cost curve. The IT tools necessary to keep people healthy are quite different from those needed to document episodes of care when they are sick. Part I provides valuable insights into the care coordination tools needed in the future to reduce cost and improve quality. Although the Obama administration’s Meaningful Use program has had mixed results, public health reporting of immunizations, syndromic surveillance, and reportable lab results has been implemented successfully at a national scale. You’ll learn how that was achieved in Chapters 1–4.

In Part II, you’ll learn about the major issues shaping health information science. Today’s hot trends include team-based communication, mobile computing, analytics, and cloud computing. In 2017 and beyond, I believe that the role of IT leaders will fundamentally change from choosing and integrating the best technology to managing complex projects successfully and ensuring a highly usable result. All of these issues are discussed in Chapters 5–12.

Part III focuses on standards and regulation. An old joke notes “the great thing about healthcare IT standards is that there are so many of them.” Creating standards is complex and involves harmonization of multiple stakeholders with a near infinite number of use cases. What is the difference between harmonization and compromise? Harmony means that everyone is happy with the consensus. Compromise means that everyone is equally unhappy with the consensus. Since standards are adopted by consensus, achieving harmony means that standards include a little bit of everyone’s wish list. The danger is that a consensus approach to designing a duck could produce a platypus—it’s supposed to be a bird with feathers but turns out to be a mammal with hair. You’ll hear from experts about the Meaningful Use standards and how we attempted to balance the needs of the many with a relatively low burden for developers, then wrote it into regulation.

Part IV focuses on the day-to-day operations of healthcare IT organizations. I’ve been a CIO for 20 years, and during that time, we’ve evolved from products that had to be self-developed to highly reliable commodity services available at reasonable cost. Keeping IT running flawlessly while also introducing continuous improvement/change takes hands-on management and a thick skin. You’ll hear from leaders in the trenches in Chapters 18–22.

Part V focuses on innovation. I sometimes describe introducing new technologies into mission-critical production systems as changing the wings on a 747 while it’s flying. The world of big data, precision medicine, genomics, and telehealth requires us to break old paradigms of architecture and functionality while not interrupting existing care processes and revenue cycles. There are risks, but risks can be mitigated with appropriate planning. You’ll learn how in Chapters 23 and 24.

Part VI focuses on security. Today, as CIO, I spend 25 percent of my time on security-related matters. The new threats are no longer bored college students. We’re dealing with state-sponsored cyberterrorism, hacktivism, and organized crime. I describe healthcare IT security as a cold war. The faster the good guys innovate, the faster the bad guys innovate. We’re asked to share more data with more stakeholders for more purposes but never spill a single byte. It’s an impossible task. You’ll hear from the experts who created many of the regulations and best practices we’re using today to keep information private.

I hope you enjoy this book as much as I have and that it finds a place of importance on your bookshelf. Regardless of the political and economic divisiveness we’ll encounter in the world over the next few years, we know that healthcare IT automation is a universal priority in every society to optimize existing resources and keep our aging societies as healthy as possible. Be well!

John Halamka, M.D., M.S.
International Healthcare Innovation Professor at Harvard Medical School
Chief Information Officer of the Beth Israel Deaconess System
and a practicing emergency physician