This article originally appeared on the BeyeNETWORK
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It would be silly to vote for a presidential candidate based on a single issue or on just one component of that person’s campaign platform. Nevertheless, most of the candidates in the 2008 presidential race are missing a key opportunity by neglecting to include business intelligence in their healthcare plank.
In July 2007, Dr. Susan J. Blumenthal, M.D., Jessica B. Rubin, and Michelle E. Treseler published an analysis of the healthcare information technology (HIT) solutions in the presidential candidates’ platforms. Their article did a wonderful job of comparing the candidates side by side in terms of where they stand on the use of IT in general. In other words, they did not make a distinction between information technology for operational purposes, for communications purposes or for analytical purposes. In truth, only a few of the candidates put out statements that outlined their HIT plans, and some did not even mention healthcare as an issue at all.
I would like to drill down one step further into this analysis by describing the healthcare business intelligence that is included in the candidates’ platforms, as well as where opportunities exist in the platforms for discussion of business intelligence as a potential solution. Hopefully, this will provide voters with a more informed view of the tangible improvements that could be made to the healthcare industry as we face enormous issues such as double-digit inflation, increased consumerism, an increasing population of uninsured, looming shortages of skilled practitioners and, of course, the ever-present pressure to improve quality and service and still make money.
Key Issues in the 2008 Presidential Campaign
The key issues in the current campaign should come as no surprise to anybody. In order to win votes, every candidate addresses to some degree the war in Iraq, the war on terrorism, the economy, education, constitutional rights and, of course, healthcare.
Drilling into healthcare, the critical sub-issues center on financial access to healthcare (i.e., health insurance) as well as quality of healthcare (clinical quality, availability, safety, etc.). For those candidates who make statements on healthcare, the dominant solution to financial access revolves around the mechanism for ensuring that every American has the insurance they need that is affordable. The split between the major parties comes as to how to do this. In general, Republican candidates favor market-based solutions while the Democrats seem to favor universal health plans sponsored by the government.
On the other hand, the solution to the healthcare quality problems is (again, when mentioned) unanimously a call for better information technology. Some candidates, as you will see below, spend a lot of time outlining plans to improve the nation’s information technology infrastructure. Of those who do make detailed statements, only a very few describe these plans in terms of HIT for operations, for communications or for analysis.
Three Types of Healthcare Information Technology
Healthcare information technology, and for that matter information technology in any industry, falls generally into three major types based on the problem they are developed to solve:
- Operational information technology. This group represents the core systems used to run the business from day to day, from paying the bills, charging patients for services, scheduling appointments, gathering patient data, handling admissions/discharges/transfers and so forth. Healthcare as an industry is behind in exploiting the computer to manage these everyday tasks as compared to the banking, insurance, retail, manufacturing, transportation and communications industries. This is not news. Well, actually, this fact makes the news every day. And our presidential candidates are making use of this news to win votes.
- Communications information technology. This technology group deals with the ability to not only run the business using IT (i.e., operational information technology), but also getting the right information transmitted to the right people at the right time. Once again, this is newsworthy and resonates with voters. How many of us see a specialist after seeing our primary care physician, only to find out that the file (often a file folder full of handwritten paper documents) has not arrived yet? Or how many of us have spent hours on the phone with our health plan trying to clear up a problem with our EOB (explanation of benefits) for a service that occurred months ago? This technology need rings true with voters and therefore gets a lot of attention in several of the candidates’ statements.
- Analytical information technology. The third major technology group concerns the use of the operational information as well as the communicated information to make evidence-based healthcare decisions. These decisions could impact medical effectiveness, they could affect service efficiency, or they could be strategic in nature such as which patient groups to serve, how to serve them and why. With one notable exception (Senator Chris Dodd’s platform), this application of information technology is hardly touched upon. This is not surprising since analytics and analytical applications are not widely familiar to the public and, therefore, not likely to ring up as many votes as the other two types. This situation represents an overlooked opportunity by the presidential candidates, which I will explain below.
Platforms Containing Healthcare Business Intelligence Solutions
None of the presidential candidates directly mentions “healthcare business intelligence” or even analytics as a means to solve the nation’s healthcare issues. Frankly, I would not expect them to. The term “business intelligence” is not in our everyday vocabulary; and to the average person, the term would probably conjure up notions of corporate spying, similar to military or national security intelligence. There are, however, business intelligence applications showing up in several of the candidates’ writings under different names. The one trait these applications share is that they use the vast amounts of data in various healthcare organizations for analytical purposes to make better clinical, financial, business and economic decisions.
The following is a listing of the analytical solutions put forth by the candidates (or not), which was mined from information provided on their websites. Instead of putting the candidates in alphabetical order, I put them instead in order of how deeply and how directly they speak to the promise of analytical solutions to address key healthcare issues.
Is this an endorsement of a particular candidate or a particular political party? No. It is just a list of issue statements with the strongest business intelligence message bubbling to the top.
- Chris Dodd. This is by far the strongest message in terms of using analytics to address healthcare issues. Senator Dodd speaks of several business and clinical analysis applications including disease management, care management, clinical decision support and utilization management.
- Joe Biden. The message here is focused on communications (i.e., a uniform system to submit health claims). A detailed description is provided of the issues that analytics can help solve, including chronic care management, co-morbidities management, clinical effectiveness and economic analysis of care provided. In addition, this message describes the use of RHIOs (regional health information organizations) for sharing and analyzing patient population information.
- John Edwards. His message includes components of all three types of health information technologies: improved operational systems such as paperless medical records; improved communications such as CPOE (computerized provider order entry), telemedicine, wireless devices and patient reminder systems; and improved analytical capabilities to evaluate quality, safety and efficiency.
- Barack Obama. Description of HIT includes collection and reporting of quality, efficiency and safety data. His information technology applications also include disease management program support, price transparency and preventable errors (e.g., nosocomial infections) analysis.
- Sam Brownback. Would push for creation of a lifetime electronic medical record (EMR), which means the patient would most likely carry it with them from provider to provider (i.e., a communications technology). No mention of using these EMRs for analysis purposes. However, does support price transparency to promote consumerism, which increases the need for providers, payers, purchasers and patients to drill into the specifics of services (i.e., an analytical application).
- Bill Richardson. The message is distinctly operational – streamline administration with common forms and reports. Promotes several analytical applications such as evidence-based medicine, comparative effectiveness research, pricing and quality transparency, etc.
- Hillary Clinton. The message here is clearly focused on improving communications technologies, both inside healthcare organizations as well as among organizations.
- Mike Huckabee. Supports adoption of electronic medical recordkeeping (operational application of technology). No mention of analysis applications.
- Dennis Kucinich. Supports the creation of a standardized electronic health record (EHR), which is an application of operational information technology and can be used to improve communications among providers. No mention of analytical applications.
- Rudy Giuliani. No mention HIT.
- Mike Gravel. No mention of HIT.
- Duncan Hunter. No mention of HIT.
- John McCain. No mention of HIT.
- Ron Paul. No mention of HIT.
- Mitt Romney. No mention of HIT.
- Tom Tancredo. No mention of HIT.
- Fred Thompson. No mention of HIT.
Issues Where Analytics Help
Analytical applications represent the opportunity that is being overlooked in the presidential campaign platforms. Basic operational applications such as EHRs and improved administrative recordkeeping systems have been promoted in political campaigns for decades. Improved health information communication technology showed up in the last two presidential races. In order to take their message to the next level, the candidates should include analytics in their platforms. This is true for a number of reasons:
Analytics drives adoption of operational and communications technologies. EHR adoption among hospitals is often quoted at roughly 25-30% and at 12-15% among medical practices. One of the reasons for low adoption is the upfront investment in the technology that does not seem to have a clear payback. Analytics changes all of this. When aggregated, EHR data is a powerful resource for decision making about patient populations, patient visit trends, service efficiency, quality reporting, safety and compliance reporting as well as financial investment and strategic plans. All of these are business intelligence applications. Plus, when aggregated with other providers and enhanced with communications and performance measures, this payoff becomes even greater. In effect, the benefits of analytics can be the engine that pulls the operational and communications technology boxcars. This is a unique message to take to the voters.
Analytics is the solution to many of the issues described by the candidates. Many of the “current” healthcare issues have been with us for nearly a century, including affordable health insurance, healthcare inflation, inconsistent quality and safety, and so forth. Analysis of the data we have on these and other issues can help us to finally overcome these issues. This is a strong message to take to the voters.
Analytics are entering the mainstream. Anybody who has bought a book from Amazon knows the value of analytics in the form of “customers who bought this book also bought...” or “books that may also interest you are...” We – the general public – understand analytics more readily than in the past, and we support analytics if we can see the results.
Dick Morris in his book Power Plays described one political strategy known as “triangulation” as fixing your opponent’s car with your tools. Using analytics to not only support your solution, but also to trump the opponent’s signature issues is a strong reason to make it part of your message. And healthcare is in real need of such a powerful solution.
Vote. But before you do, get a full picture of the solutions that each candidate brings to the major issues confronting the U.S. so that you can vote wisely. Healthcare is one of the key issues in the current election, and business intelligence can help address this issue in a number of ways, for a number of affected groups. We can solve the problems that plague our industry and the country as a whole, and information can help us to make solid decisions that will have long-lasting impact.
Thanks for reading!
Susan J. Blumenthal, M.D., Jessica B. Rubin, and Michelle E. Treseler. U.S. Presidential Candidates' Health Plans: Incorporating Information Technology to Provide 21st Century Care. Huffington Post. 25 July 2007.
Morris, D. Power Plays: Win or Lose–How History's Great Political Leaders Play the Game. HarperCollins, New York, 2003.