Systems engineering's critical role in health IT

The Future of our Health System – Digital, Secure, and Founded on System Engineering
A RAND Corp. study published in Health Affairs reignited the debate over how health IT can fulfill its promise of achieving significant cost savings while dramatically improving patient outcomes. While it’s true that interoperability, adoption and standardization of systems are important, the utility of the data in these systems represents the real value of heatlth IT. http://content.healthaffairs.org/content/32/1/63.abstract

The health care community’s challenges are to integrate information from these systems, ensure integrity of data, and unlock knowledge from data to realize the promises of a trusted digital health system for our patients and our nation.

As we all know, the health care industry is in treacherous fiscal terrain. As a nation, we spend more than 18 percent of our gross domestic product on health care; more than half of health care spending is government-funded; and our per capita expenditure rate is alarmingly high compared to other nations. Our healthcare system’s unsustainable economics threaten our nation’s vitality and are not justified by current health outcomes. 

Industry, regulatory, and legislative entities have responded, and progress has been made toward bending our nation’s health care cost curve. Leaders and incentives have driven private and public sector institutions to focus on coordinating care more effectively, improving care quality, providing decision support and enhanced data management, and reducing redundant costs.

Unfortunately, these efforts have been hampered by weak digital foundations in many institutions, interoperability challenges and a lack of alignment between care objectives and business processes. We haven’t made enough progress in liberating gridlocked clinical data; achieving cost savings; improving provider productivity; or, most importantly, providing patients with better outcomes.

For many institutions, the pace of progress toward these goals will determine whether the potential promised by health IT will be achieved or whether it will be trapped in a Pandora’s Box of technical, operational and cultural risks.

In many instances, the unfulfilled promises of health IT can be attributed to the absence of a fundamental and practiced tradecraft: system engineering.

 Look behind any successful complex system and you’ll find solid system engineering in the foundation; look behind a patchwork capability providing weak or uncertain outcomes and you’ll find a lack of system engineering.

Essential to the practice of system engineering is a focus on the mission the system is designed to support. In the case of health care, the mission includes providing better outcomes at lower costs. The rushed emphasis on installing product and technology over delivering mission is an implementation error that has led to suboptimal outcomes including sluggish adoption, isolated data streams and frustrated care providers.

Compare this to a home improvement project. Let’s say you wanted to build a sunroom for a comfortable spot to read a good book, and you rushed to “buy a sunroom” only to discover that in winter it lacked connectivity to the heating ducts, the ceramic tile was frightfully cold on your feet, and there was insufficient power for a portable heater - you’d be no better off than when you began.

You might have a great looking product, but without the system engineering needed to integrate it with other comforts, you don’t have a better outcome. You still won’t get a warm, inviting place to enjoy a good book year-round; in fact, you may never be able to use it effectively. And, let’s not forget the potential cost to retrofit the room for integration with your home security system.

There is a straightforward and proven approach to the issue: clearly identify desired outcomes and work backward to requirements and solutions that make sense for the business; establish return on investment objectives; include stakeholders in the process (physicians and patients as well as IT and business managers); adhere to integration and interoperability ground rules, and develop intelligent capabilities that liberate clinical data.

From our experience, system engineering is the foundation of a successful complex system that unlocks data to deliver better outcomes and lower cost.

In the defense and intelligence sectors, you acquire data from a wide variety of ground, air, and space assets; aggregate it and perform analytics to provide real-time intelligence and situational awareness for troops on the ground. It’s like finding a needle in a haystack in an environment where timing and accuracy are paramount.

The same urgency applies to efforts in the health care sector, where it’s imperative that systems of care operate smoothly so caregivers have accurate, timely and actionable information enabling them to deliver optimal patient care. Today’s physicians and health professionals are bogged down with the pressures of data entry across multiple proprietary systems that lock their information into data silos and hold organizations hostage to product upgrades.

Unlocking these data streams, adopting open data platforms and providing clinical analytics are essential to successful HIT deployments.

While the industry intensely focuses on information privacy, little attention is paid to information security. As we digitize our health care systems, we have to be prepared to address the security threats that emerge – the possibilities of altered prescriptions, leaked sensitive and private information, and data corruption at the point of care.

As health data becomes increasingly digital and aggregated, it becomes a higher priority target for cyber exploitation. Steps must be taken to incorporate advanced cyber protection concepts that protect newly digitized information while securing the points at which this information interacts with other systems, devices and caregivers.

It is clear that health IT is an essential element in the evolution of healthcare systems. However, in many cases we are not following a prescription for rigorous system engineering to help deliver better outcomes using systems currently hampered by haphazard deployments.

From my experience it is clear that system engineering, cybersecurity, and clinical data liberation with analytics are the diet for a healthy digital healthc are system that achieves better patient outcomes at lower costs.