Perhaps it's just the summer heat, but I'm starting to feel that regional health information organizations, national health information infrastructures and electronic health records might not be that sexy anymore.
Granted, health IT and information exchange have never really been great cocktail catalysts, but over the last couple of years, health IT has enjoyed broad national attention by the mainstream media, as well as by executive and political leaders. And departing health IT czar Dr. David Brailer has enjoyed near rock star status in helping to activate a traditionally staid industry.
As of late, however, it seems that the fresh energy and thinking in health IT has begun to wilt. The difficult reality of implementation and getting the work done has returned to the forefront. Are we near the top of a dreaded "hype cycle"? Are we at an inflection point where the fruits of our concerted efforts will come to bear in the next several years? Or, as with many previous hype cycles, will our efforts become bogged or stagnate due to organizational inertia?
Hype Cycle
It was the Gartner Group in 1995 that popularized the graphical curve that described five hype cycle phases that characterize the perception of new technologies or concepts as they become propagated:
- Technology Trigger;
- Peak of inflated expectations;
- Trough of disillusionment
- Slope of enlightment; and
- Plateau of productivity.
The phase titles are fairly self-explanatory and, in many ways, characterize the inherent manner in which humans build and manage expectations.
Though Gartner typically uses the curve to follow specific technologies through a hype cycle, one can also see how a whole industry can follow a similar path. Over the last couple of years, health IT has enjoyed a significant resurgence in exposure and mindshare, triggered by a convergence of factors, which include:
- The promise of federal activity;
- Cheaper technology; and
- Increasingly vocal and visible stakeholders.
The vision for an information superhighway in health care, as embodied in the NHIN, captured imaginations and spawned innovative ideas in health IT.
But a static hope and vision can only fuel expectations for a finite period of time. As we know, the reality of implementing health IT transformation is a much longer and difficult undertaking than our imaginations can endure, so, in many ways, it's inevitable that we reach a "topping point" in hype and progress into a dampened, if not disillusioned, state over a period of time. Real change takes time. Humans by nature are not patient.
Real Work
Despite -- and because of -- the hype, real work on health IT nevertheless is under way. Just a few years ago, mention of the term RHIO would have conjured up images of exotic Latin American dancers or a somewhat dated casino in Vegas. Today, as many as 50 RHIOs are in development, and almost half of them are in start-up phase. The number of small and new companies intending to service these RHIOs also is growing.
Depending on how you define adoption, the number of physicians with EHRs is expanding, with estimates of as many as one in four physicians nationally. Smaller medical groups increasingly are interested in evaluating EHRs, and many larger groups consider them the standard of care.
Beyond the work and statistics that are much more visible, there is also real work occurring at a smaller scale across the country -- small technology startups, local technology-sharing initiatives and weekly meetings about IT strategy and implementation. These are the seeds of future enlightenment and productivity.
To Tip or To Top?
As we begin to hit the inevitable top of our current hype cycle, it remains unclear what impact that may have on the current fledgling work occurring in organizations, small and large. Will practice administrators and providers simply lose interest in implementing IT? Will large institutions divert resources to more immediate needs and projects? Will open and collaborative exchange come to a halt? Unfortunately, just as hype can motivate individuals to behave in a concerted fashion toward the positive, the lack of hype or negative hype can cause individuals and organizations to recede as quickly. For some, a large investment has already been made and managers have "seen the light" to persevere - no matter how the national dialogue might shift. For others, organizational inertia and the complexities of change management may simply overwhelm any desire to follow through with a unified health IT vision.
The health IT industry has certainly seen many hype cycles over the last few decades. And it appears that we are in one now. The implications of this cycle, however, seem more significant than those that have preceded it. The dialogue is more global, the scrutiny more visible, and the factors for change more plausible.
What happens in the upcoming years and how individuals respond to a fall-off in hype will be critical for those who believe in the vision for health IT. A regression in activity could prove disastrous and result in more drastic mandates and calls to action. But achieving some intermediate milestones or highlighting some innovative breakthroughs might be enough to keep the fuel burning and inspire next generation leaders to step up and push health care into the 21st century.
About the author:
Dr. Thomas Lee is a physician entrepreneur and consultant who builds software systems and medical organizations for physicians in practice.
The views expressed in this column are those of the author and do not represent the views of the California HealthCare Foundation or the Advisory Board Company.