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Conventional wisdom often tells us that the evolution of healthcare technology grew from the steady growth of legacy, incumbent back-office systems. We started by using computers with hospital or office accounting and inventory management systems, then graduated to clinical applications like PACS and LIS and finally started to develop online patient records that could bring clinical data to networked locations that could be quickly reviewed from any secure, networked device.

With the advent of CPOE and clinical decision support, a dramatically higher order of technology integration was required. The days of countless ‘best of breed’ technologies tied together with intricate interfaces began to fade in exchange for implementation of large, complex, integrated systems that stood a better chance at meeting clinicians’, patients’ and other operators’ needs by providing rich, integrated data management solutions and improved patient outcomes.

I’ve always thought this evolution was like when our wagon trains were replaced by railroads in the Old West. Wagons on the trail varied in size, speed, and reliability. They were mostly all heading down the same roads in the same directions. They were slow but steady traveling around 4 mph during daylight. Some were more successful than others in getting the job done; just like many legacy, freestanding applications.

But people wanted faster and better. They wanted fast, new, shiny, affordable and reliable trains that would carry mail, cargo, and passengers across the country wherever they wanted to go.

So, groups of people were assembled to build a railroad. Investors were sold on the ideas, new companies formed and a lot of money was raised. Plans were drawn up and the adventure began. Explorers were followed by field offices and telegraphs. The land was purchased and contracts signed. Surveyors drew maps and engineers developed plans. Laborers were brought in and a lot of digging, demolition, bridging, hammering, moved forward as the tracks were laid here and there across the country.

The work was dangerous and costly. Forts and outposts were built to protect and supply the workers. Crews could be attacked by the natives at any time with frequent loss of life. There were delays due to weather, failures and temporary loss of financing. Sometimes insufficient labor forces required management to recruit and transport incremental resources at an unexpected premium cost. Projects were complicated by last-minute changes to the plan and communication breakdowns.

Ultimately, the railroad was built; the last spike was driven and trains started to roll. Passengers flew up and down the tracks, across bridges, over mountains and through deep valleys and canyons at well over 20 mph.

But people still complained. The trains were bumpy and smelled of smoke. They broke down. They were hot; air-conditioning didn’t exist in the 1800’s. And unless you were on the train, you never knew exactly where it was. It was better but it wasn’t good enough.

Just like large-scale enterprise EHR implementations. Things are better than they were but we still have a long way to go. The evolution of railways should always be considered by health system leaders starting (or traveling) down this road. The evolution of healthcare is a lot like that of trains.

Evolution of Healthcare and Trains – the Rules:

  • All railcars need to be connected Patients’ lives are at stake and health systems’ budget and resources are more limited than ever. Leaders must develop and broadcast strategic, long-term operational and IT roadmaps that clearly align system goals with technology initiatives.
  • All the rail cars need to be on the (same) track Health systems are systems and not holding companies. Successfully leveraging economies of scale and improving quality by spreading best practice or reducing variability demands buy-in and collaboration across the team. Leaders need to spend time talking with their teams about both what they will and very importantly, will not be doing and why.
  • All the rail cars need to go in the same direction Successful execution of information technology solution planning requires clinician and other operators’ engagement and operational ownership from project inception through ongoing operation. Creating and communicating an IT roadmap must include plans for systemwide, uniform communication, developing consensus and implementation.
  • Railroads run on a schedule We must maintain transparency throughout implementation and hold ourselves accountable. If we plan for an implementation to take 18 months it will take 18 months. If we plan for an implementation to take 22 months it will take 22 months.
  • Railroads don’t move very quickly if they’re not on the track and problems can arise when schedules conflict.

The goal of healthcare technology is improved outcomes, quality of care and community health. Implementation and go-live are only the beginning. Technology can never be the hero; it is just another tool. Sustainable success requires leadership that clearly articulates a vision, maintains publicly-defined scope, communicates a plan, invests in acquiring user engagement and buy-in and finally, maintains accountability for implementation and post-live optimizations. Thankfully, the evolution of healthcare continues.

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