|
About EINet
News
Briefs
Learning
tools
Data
Library search
Other
links
APEC
ISTWG
Network of Networks
Meeting
EINet home
|
Seattle, Jan.
29, 2002
Good
evening.
Thank
you for the opportunity this evening to discuss IBM’s view
on the critical issue of network readiness. I think it is important
to start out by stating that even as the world’s leading
information technology company, at the IBM Corporation we do
not see information technology — whether computers, software
or networking — as a solution to such vexing problems
as the spread of infectious disease. Rather we see information
technology as an enabler of solutions. There is no doubt
in my mind that the real innovation, commitment and follow
through to aid in identifying and treating infectious disease
will come from the type of “networking” this meeting
represents — the reasoned consensus of experts in
the field and those responsible for implementing
the solutions that are designed by you and your colleagues.
In
fact, though I will cover our experiences and conclusions regarding
network readiness, I will also discuss some of the challenges
involved in implementing any networking or other healthcare
solution once the assessment is completed. I’ll provide
some examples from here in the United States on how these implementation
challenges are being met. While I realize there are enormous differences among the member economies belonging to APEC,
hopefully the lessons learned through some of the work we have
been involved in will be of benefit to each of you, no matter
what the state of your healthcare delivery system or other economic
and social factors.
So
what I will take you through first is why assessing network
readiness is an essential first step in improving any
system for controlling and treating infectious disease. Since
19 of the 21 member economies of APEC participated in last year’s
E–Commerce Readiness Assessment — in which IBM also participated
— I won’t dwell on the necessity for this initial
step, since clearly doing initial assessments is a process and
discipline that APEC member economies have found valuable. But
I will describe some of the details on how an assessment is
executed.
Second,
I will discuss why IBM is such an active and committed participant
in these efforts. I will point out the causes and circumstances
that not only bring IBM to the table, but are also the
reasons other commercial entities and information technology
providers participate in such efforts as well.
Third,
I will share what have been some of the common gaps identified
in these readiness assessments, so that these areas are highlighted
for your consideration.
And
finally, I will touch upon some of the implementation challenges
we have seen when the assessment and solution phases lead to
the implementation phase, and how in the United States two large–scale
efforts have proceeded to address these challenges. I will first
discuss Kaiser Permanente’s multi–billion dollar project
to deploy a comprehensive outpatient healthcare management system
across their 8 million membership base. I’ll then review
a recently established collaborative effort to use healthcare
information networks to combat bioterrorism, an effort
that grew out of the tragic events of September 11th.
And we should have some time for questions at the end.
Let
me start with network readiness assessment. There are a number
of public and private organizations leading the creation of
processes and tools to aid with these assessments. At IBM, we
have had a long–standing involvement with organizations like
the Computer Systems Policy Project, or CSPP. CSPP is
a public policy advocacy group in the United States that addresses
broad policy issues that impact technology development. Its
membership is limited to the Chairmen and CEOs of America’s
largest technology companies. IBM Corporation Chairman and CEO, Louis Gerstner, Jr., is CSPP’s Chairman. Organizations
such as APEC, and the Pan American Health Organization (or PAHO),
as well as many more local bodies have taken the CSPP practices
around network readiness assessment and used this information
as input into developing the processes for network assessment
that best fit their environment and circumstances. CSPP’s
work can be readily accessed at www.cspp.org.
In
work we have done with PAHO and other organizations around healthcare
network readiness assessment, we have found that focusing on 3 key areas works well. These 3 areas are
- Technology,
- People
and Policies, and
- Governance
The technology topic has four sub–areas that are essential
to the network readiness assessment. These are
- Technology
infrastructure
- Access
and Connectivity
- Applications
and Services
- Data
Integrity and Protection
Let
me give you examples of the questions that are asked
in each of these Technology categories.
-
Technology infrastructure: What is the “teledensity”
in your economy? How many dial–up connections fail because
they are busy or interrupted? What is the rate of packet loss?
— Now if no one asks me what that means in the Question
and Answer period, either everyone is concentrating on his
or her dessert or I am actually speaking at an information
technology trade show!
-
Access
and Connectivity: What is the capacity of access services
available to users (i.e., less than 56Kbps, 56Kbps, broadband
connections through cable or DSL)? How restricted is the market
for Internet Service Providers (ISPs)? What percentage of
the population has access to the Internet? What is the current
growth rate in Internet users? What are the prices for Internet
access? What percentage of the users have mobile or cell phones?
What is the capability of the economy to distribute end user
devices such as PCs? What is the demographic profile of PC
users? What is the number of healthcare service providers
(such as hospitals) using the Internet or communicating with
other healthcare network participants by other electronic
means? For what purposes are they using these electronic networks?
-
Applications
and Services: What applications are used by participants
in the healthcare delivery system? What percentage of those
applications is produced in the economy vs. externally? What
percentage of the appropriate end users for these applications
is currently using each application? What healthcare processes
are working well and can be automated or digitalized to reduce
costs and improve their effectiveness? What are the economy’s
policy and the healthcare establishment’s goals with
regard to data and/or content standards?
-
Data
Integrity and Protection: What percentage of websites
utilizes secure socket layer (SSL) technology to enhance the
security of end users? To what degree is encryption allowed
and how is its use regulated?
Under People and Policies, there are 3 sub–areas:
-
Organizational
structure, where questions are asked about the managerial
and workplace organization of the healthcare delivery system
as well as how different entities relate as part of the care
process.
Staffing
and training, where there are questions such as: How is computer
literacy addressed in the medical and professional training of
healthcare practitioners and administrators? Do schools and training
programs for healthcare professionals have access to recent technology
and applications? What is the availability of trained IT support
personnel? And,
-
Protection
of data security and privacy, where questions are asked
about the policies in place, and the effectiveness with which
they are enforced, to ensure the technology and practices
leading to superior data security and privacy are adhered
to.
And
finally, under Governance the assessment asks questions
about how the healthcare system manages itself and deals with
conflict, and examines the professional backgrounds of the individuals
making clinical and healthcare policy and funding decisions.
There are also regulatory issues: How is the market for telecommunications
regulated? Has the economy acceded to the WTO Information Technology
Agreement to enable optimal market conditions and pricing? How
many licensees exist for cellular, PCS and/or packet data networks?
How is the economy addressing the regulation of networking issues?
Is there an accepted legal framework addressing these issues?
Where does liability for unclear areas lie?
So
if these are some of the questions asked in a network assessment,
what is the potential role for entities such as IBM and
why are we involved in these processes? First, as a global
company with over 300,000 employees and millions of customers
in 160 countries worldwide, we are active in broad public
policy issues that are germane to our business, our employees
and our customers. However, our particular involvement in readiness
assessments, whether through the CSPP, PAHO, APEC or other organizations,
reflects some conclusions drawn from our work with governments,
research laboratories, corporations and small and medium businesses
worldwide. One key conclusion was that these change efforts
— and most of these efforts, including finding better ways
to address infectious diseases, are change efforts —
should be based upon independent, quantifiable, data.
Another lesson learned was to first develop a consensus on what
the “ideal situation” would look like along
key operational and policy dimensions. Once this “ideal”
is agreed to, a rigorous process to perform an assessment and identify the “gaps” between the current state
and the ideal can be performed.
Which
leads us to discuss our third topic of the four I’m covering
in this presentation – what common gaps have
been identified in network readiness assessments? In many economies
outside the largest and more technologically advanced economies,
one of the biggest gaps has been the inadequate condition
of the technology infrastructure. It is not only important
to look at the current state of technology infrastructure, but
to review the mechanisms in place (or not in place) to continue
to invest and maintain that infrastructure over many
years. We have seen this problem addressed through additional
opening up of the economy, and/or through public–private partnerships
to develop and manage infrastructure, which I’ll describe
a bit later in one of my examples.
The
next two areas where there are typically gaps vs. the “ideal”
were seen even in the economies with higher GDPs per capita.
The first is that there are typically issues around governance.
In the healthcare sector, these challenges are particularly
acute. Improving the health status of a defined population involves
the family, the school, the workplace and the health care delivery
system at a minimum. Most of these entities are heavily influenced
by government policy. Often the stated goals following a network
assessment are far ahead of the practical ability of the institutions
in the economy to act to achieve those goals. Second,
another area where there often appears to be large gaps is around aligned incentives. We all know that any change effort
has to start with “unfreezing” people from their acceptance
from their current state and identifying a “future state”
that they aspire to. The readiness assessment helps with both
of these objectives. Where problems then occur is in causing
all the parties that must collaborate to feel a sense of urgency
and commitment over long periods time to reach milestone events
on their way to the Promised Land. This has proven to be often
an insurmountable challenge, and results in great plans for
improvement sitting on senior executives’ bookshelves while
the problems persist.
However,
let me close with two examples of projects that are grappling
relatively successfully with some of the issues I have just
described. They are both examples from the United States, but
I will describe how they represent universal approaches to addressing
challenges in this area./font>
The first example is Kaiser Permanente’s implementation
of a clinic, or out–patient–based, electronic health record.
For those of you not familiar with this organization, Kaiser
Permanente is one of America's leading integrated health care
organizations. Founded in 1945, it is a nonprofit, group–practice
health maintenance organization (HMO) with headquarters in Oakland,
California. Kaiser Permanente serves the health care needs of
members in 9 states and the District of Columbia with over 8
million members, over 50,000 clinicians, over 11,000 physicians,
29 medical centers and over 40 medical offices. Kaiser’s
revenue in 2001 was approximately $20 billion.
Kaiser
has long recognized the positive impact digitizing and communicating
its members’ healthcare information could have on making
that information available where and when it is most needed
— at the point of care. Three of its regional healthcare
groups — in Ohio, Colorado and here in the Northwest —
have won the prestigious Davies Award for excellence in implementing
computerized patient records in their clinical environments.
The Kaiser Colorado electronic health record system has resulted
in the almost complete absence of paper medical records in their
clinics. Instead of the (paper) chart being available for the
caregivers only 60% of the time when the patient arrives in
the exam room, it is available 100% of the time, greatly aiding
the care process.
In
the mid�’s Kaiser decided to seek the leverage and
impact it could have from acting as one national entity, rather
than a loosely coupled series of regional groups. Therefore
they decided to take the electronic health record that had been
developed for their Colorado group of caregivers, expand its
capabilities, and implement it nationally. The project is called
KP–CIS (CIS stands for Clinical Information System).
What
have been some of the main lessons learned from Kaiser’s
experience?
-
Create
a mechanism to ensure consensus is reached on what the system
needs to do, by when, and at what cost. Kaiser spent years
trying to develop this consensus among its leading groups
— finally the implementation of the system in the Hawaii
region helped bring about the realization among all parties
that they needed to iron out their differences in order to
avoid overly burdening the project with expense and complexity
as it rolls out nationwide.
Ensure the system is “owned” by the business leaders,
especially the physician leadership, vs. the technology folks.
Any information technology project can begin to consider itselfan
IT implementation project that must succeed at any cost, rather
than as a means to improving the care process (and a means that
should periodically re–evaluated to see if more cost effective
alternatives exist). Kaiser now applies return on investment
criteria relating to its clinical improvement goals to all expansions
of KP–CIS.
Deploy as fast as you can, as broadly as you can; leave
the bells and whistles and functional improvements to be addressed
once the system is deployed broadly. The benefits to patients
and caregivers from electronic health records are so substantial
that getting these systems deployed as broadly as possible should
be the initial goal. Caregivers and other users’ desires to
add new functionality should be resisted until after broad deployment
unless the return on investment is overwhelming.
While
the deployment of an electronic health record by a $20 billion
healthcare provider may seem far removed from the needs you
have been discussing to address infectious disease, let me end
by describing an initiative in the United States that is quite
relevant. All of us were shocked and saddened by the events
of last September 11th. Following those tragedies,
we saw the advent of bioterrorism in the United States, with
five people killed from inhaling anthrax spores in Florida,
the Washington D.C. area, New York and Connecticut. A “readiness
assessment” was performed by the Centers for Disease Control
(CDC), the new Homeland Security Office, and other agencies
and they concluded that there needed to be substantial improvements
in the way the fragmented U.S. health system dealt with potential
and confirmed outbreaks of bioterrorism.
Therefore,
two weeks ago the CDC and the eHealth Initiative, supported
by the Joseph H. Kanter Foundation, announced a collaborative
effort to bolster the public health infrastructure and improve
the United States’ preparedness and response to a potential
large scale bioterrorism event. This initiative will initially
focus on leveraging current healthcare information systems and
existing data streams (including the CDC’s National Electronic
Disease Surveillance System (NEDSS)) to enhance public health data collection, surveillance, and detection processes.
This
initiative is significant in many respects, but in relation
to the issues raised earlier in my presentation tonight on implementing
new network solutions to improve healthcare delivery, these
are two very significant aspects of this initiative:
-
This
is a public–private sector initiative, seeking to
align interests across many constituencies in the U.S.
health care system. Russ Ricci, MD, Global General Manager
of IBM’s Healthcare Business Unit, is the Chairman of the
eHealth Initiative (eHI). All major information technology
companies active in healthcare are participating and have
agreed to start with a small data set across which they will
establish data and transmission standards; later the initiative
will expand to more data sets. The members of eHI provide
health systems for 80% of the hospitals in the United States
and manage over 25% of our pharmacy information. There has
never before been an effort this inclusive focused on addressing
this public health risk. As Claire Broome, MD, senior advisor
on integrated health information systems at the CDC, noted,
“Coordination between the CDC and eHI could permit the
information systems of public health departments and a majority
of the hospitals in the U.S. to operate in a more interactive,
efficient manner that is consistent with national standards.
This will also help us address our common health improvement
goals.”
Second, the parties have their interests relatively well
aligned. The government and the American public receive
a more timely and efficient public health system to fight bioterrorism.
These leading healthcare technology companies further differentiate
themselves from their smaller, uninvolved competitors by ensuring
these new standards interface effectively with their installed
base. And the nation’s caregivers, already overburdened by managed
care and greatly reduced funding, do not have to make further
investments in their information systems due to a government
mandate.
The
CDC – eHealth Initiative collaboration could serve as a
model for using information technology and networks effectively
to address other public health issues in the United States in
the years to come.
I
hope this presentation has illuminated some of the key aspects
of networking readiness assessments, some of the common issues
that are raised by such assessments, and perhaps most importantly
has given you some ideas on how the plans coming out of such
assessments can be implemented successfully.
Thank
you again for the opportunity to address this important
meeting, and I look forward to any questions you may
have.
|
|
|
