Response to Hospitals Are Dramatically Overpaying for Their Technology

HBR had an article that’s stuck with me all week about interoperability standards in healthcare technologies. They give a poignant example of how interoperability affects the delivery of care.

For critically ill patients on breathing machines, a simple step drastically improves their survival chances by almost 10% — from 60% to 70%. It involves programming the machine to deliver enough life-sustaining breaths, but not so much that it damages their lungs by overinflating them. Given that this intervention could prevent more suffering than many wonder drugs, one would expect that there would be zero market for a breathing machine that didn’t make lung-preventive ventilation as easy as possible. But in health care, few things work as expected. Fewer than half of patients, and in some hospitals fewer than 20%, receive this life-saving intervention.

One big reason why is that hospitals purchase technologies without requiring that they communicate with each other. The optimal air flow is based on a straightforward calculation using the height of the patient. Height data, however, resides in the electronic medical record, which typically does not communicate with the ventilator. As a result, physicians must retrieve this information from the medical record, perform the calculation (sometimes on paper), and enter the order. A respiratory therapist then takes the order and types it into the ventilator, often relying on memory.

Their primary recommendation is to have hospitals use their purchasing power to force vendors to improve interoperability.  Which this is a laudable goal, working at a major academic medical center I can see the challenges with that approach that would need to be overcome.

Power (and by extension funding) is often very diffuse, spread between different management structures.  In a more corporate environment, purchasing can be empowered to negotiate deals that embed certain requirements.  In our environment, on the other hand, different equipment can be purchased through different mechanisms.  Some items may be funded by the institution.  Other equipment, though, may be acquired through government grants, non-profit and private donations, or research contracts with private industry.  Because the processes, rules and ownership vary depending on the funding source, leveraging procurement to force this kind of interoperability is a significant challenge.

The recommendation needs to be further developed to address this type of structural challenge.