Improving the health of any population requires management, policy and technology systems and processes. These can be complex and dynamic.
Earlier this year, I read Population Health: Management, Policy & Technology and was drawn to the chapter of HIE governance. Initially, because of my experience with RHIOs. But, the following quote really captured my attention because it states what I have often felt in so many aspects of healthcare.
" ...our reality is that powerful individuals, often with the best intentions, devise plans and strategies, establish programs and processes, and write and enact laws and regulations. But these inevitably get caught up in ideological struggles, power politics, the election cycle, the ups and downs of the economy, and a host of other factors; and are subject to interpretation and actions (or lack thereof) of countless individuals both within and outside of government. And these complex dynamics, whereby these strategies and programs "morph" into unintended consequences, have perhaps, a greater impact on us than the laws and regulations themselves."
The chapter then uses a failed statewide (Connecticut) health information exchange to demonstrate how grand plans fail. Key lessons learned, or pearls of wisdom, outlined in this case study include:
- Lack of continuity influences what happens, and what doesn't. There can be a disconnect between policy makers' intentions and how those intentions are actualized at the local level.
- a governing body made up primarily of mandated governmental employees from various agencies does create a real lack of diversity of perspectives. Labeling something as diverse and transparent doesnt make it so.
- this lack of diversity along with a lack of robust inquiry, questioning and input can easily lead to a lack of accountability
- Government officials think and act differently from those in similar private sector roles
- sustainability has to be a focus from the beginning
- If individual board members don't have skin in the game, they will have a hard time addressing the tough issues
- Accountability comes from being held responsible and this requires establishing clear expectations, monitoring and review of results with the set expectations
- Governance not recognizing ideological norms of advisors, such as on opt-in/opt-out decisions
- In this case study, like many others, technology isn't the issue. Instead, leadership (or the lack of) and policy is the greater influence.
- Recognizing the idealized state (and cult thinking) vs critically thinking about what can realistically be implemented
- Successful HIE initiatives come from balancing power, control and building trust
At the end of the day, creating a health information exchange, or any other aspect of improving population health, requires effective leadership and the exercise of practical judgment. While this blog post focused in on the HIE governance chapter of this book, there are lessons throughout.