By Tradition, or By Design?

A few of my healthcare social media family are my friends on Facebook and so a get a smattering of work on my Facebook account. Today when I was browsing through my Facebook feed (likely avoiding some other work) I found this great question from Dirk Stanley, MD, MPH (@dirkstanley), and CMIO at Cooley Dickinson Hospital:

By Tradition, or By Design?

4 words that caused me to stop my day and think. Hopefully it does the same for you.

Dirk is a great guy if you don’t know him. I love running into him at HIMSS since he always seems to be hanging around a bunch of other CMIOs who are overwhelmed by the craziness of HIMSS. It then leads to great conversations since he’ll pose questions like the one above.

There are so many ways we could talk about the question of tradition and design in healthcare. I think we could all come up with examples where tradition was an amazing thing for healthcare and where tradition has been detrimental. The same could be said for design. Like in most things in life, it depends.

With that as framework, I’m more interested in talking about how often we’re stuck designing around traditions. When the tradition is a good thing, that can lead to excellent results. When the tradition is a bad thing, it can lead to awful results. Once our traditions are incorporated into design, it’s REALLY hard to change those traditions.

Our billing system is a great example of this challenge. EHR systems were built around the traditions we’ve created in our billing system. For doctors wanting to be reimbursed for their work, it’s been a good thing. They need to get paid and early iterations of EHR were often able to get doctors paid at a higher level just based on their ability to create more complete documentation. The tradition of creating fluffy documentation that would get paid at a higher level has now been designed into most EHR systems. Every doctors knows the impact of this and it’s not a very pretty result. Plus, now it’s EXTREMELY hard to change.

The good news is that the only way to solve this problem is to design new traditions that avoid these challenges. That’s what they’re trying to achieve with ACOs. Although, the above example should be a warning to those designing these new reimbursement models. If you design them well so they become a tradition that’s integrated into our systems, all will be well. However, the opposite is also true.

By Tradition, or By Design? I’d love to hear your thoughts.