How About Funding?

More of the details about EMR funding under ARRA HITECH are coming out and our understanding is starting to settle down. Many well respected EMR solutions require a "front-loaded" investment - large checks need to be written in advance of earning the ARRA financial incentives. Very bright folks are proposing that Bond Funding will be needed to support timely adoption. But there is still this "credit crunch" and governmental units and health care organizations are finding this type of funding to be unavailable - or very expensive.

Some emerging EMR solutions are "no fee" buy may involve a commitment for the EMR vendor to "sell properly de-identified health records for approved research purposes" to keep the "no fee" feature. The terms of this "deal" may not be comfortable for all providers and all patients. And, there may still be too large an up front cost for customization, implementation and training. What good are unlimited training webinars if ONE webinar does not enable some initial success?

We've seen the press releases from vendors who talk about "funding their customers." Yes, it is possible to create lending vehicles to support product purchases and have it all look like good business that meets the vendor's financial metrics. But how do we discern a "good funding plan" from those that stray over into the issues that foretold the Alt-A Mortgage Meltdown - eager purchasers being told to "put down the right answers, sign and GO?"

The emerging solutions are still being vetted. It make take "the voice of the market" to understand what will really play well to help get things moving...

Another Essential Question

Evaluating the opportunities in the ARRA of 2009 HITECH division is a must-do for healthcare leaders.  Health IT executives I've met recently are clearly taking a serious look at "meaningful use" - not just thinking about qualifying for incentive bucks - or avoiding future disincentives, but really looking hard at what makes sense - for their healthcare enterprise and for their "local provider community."

And right there we ignite Another Essential Question.  Hospitals and Larger Medical Groups apply Vertical Management to achieve quality and compliance.  Many of the emerging regional efforts for Health Information Exchange have sweated hard to get Vertical Management issues "right" now that HIE technology is no longer seen as "beyond our grasp."  Yet the Horizontal Momentum of tens of thousands of PDF Healthcare Visit Summaries flowing out of CVS Minute Clinics and growing numbers PDF Thumb Drives in the hands of Kaiser members starts to look like Prof. Clay Christensen's disruptive innovation cycle emerging all around us.  What do we do?

Integrating the Horizontal and the Vertical has always been a core challenge of human enterprise.  We convene and manage with Vertical structure, a human propensity.  Yet most good action flows through Horizontal momentum.  The emergence of the internet showed, perhaps more than any other recent development, that repeatable Horizontal momentum easily supports strong Vertical structure (e.g. Amazon, Google, Facebook, Twitter).

What will happen next in healthcare?  Will these new forms of Horizontal Momentum spawn their own Vertical Management and Structure that disrupts our old line leadership organizations?

Perhaps our ability to embrace and manage technology will allow us call some of this "disruption" a good thing.  There are use cases in the emergence of Personal Health Records, as well as in patients showing up with a PDF Healthcare document that can be viewed, printed or consumed for embedded HL7 and ASTM format XML data feeds.  Any organization that has the opportunity of such simple uses cases as patients showing up with consumable or printable data can leverage the investment of others.  THAT is an Essential Question - which strategies will help today's icons of excellence in health care leverage these potential disruptions? Which strategies will bring an unexpected sunset?  And which will create unexpected, even viral growth?

No matter how this turns out, the coming months should be a very interesting time for all of us!