IT Spending: When Less Is More

Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data

By Dr. John Halamka

When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.

During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.

Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.

Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?

Too Much Data

Did the financial-services industry have controls, risk analysis, or a memory of previous crises ranging from the Depression to the Japanese banking debacle to the collapse of Enron and WorldCom? Was it greed, irrational expectations, or too much data and not enough wisdom that brought down these institutions?

We in the health-care profession naturally take no delight in the financial industry's descent. At the same time, we're trying to make the most of our IT spending and make wise choices with the data we've amassed.

One of the challenges of being a doctor in the 21st century is information overload. More medical literature is published every year than a doctor can read in a lifetime. As electronic health records become more common, doctors can be overwhelmed with data gathered about each patient. They do not want to review hundreds of normal findings; they want to know the information that can be acted on to keep patients healthy.

Wisdom, Instantly

Health-care CIOs need to implement applications that filter data so that it becomes information, that transform information into knowledge, and that ultimately provide clinicians with wisdom based on that knowledge exactly when they need it.

Suppose a patient's blood pressure is 100/50, typically considered low but not necessarily problematic. That's data. Now suppose the patient has a 10-year history of relatively high blood pressure of 150/100. That's more information. Finally, suppose the patient has a known history of high cholesterol and is now experiencing chest pain. The sudden drop in blood pressure could indicate a heart attack in progress. That's knowledge. The patient needs an aspirin, oxygen, and nitroglycerine medication immediately. That's wisdom.

Recently I asked my primary-care physician to export my entire history from his electronic medical record system. Although I'm a completely healthy person, the result was a 77-page document. It contains a mix of administrative and clinical data, numeric observations, and unstructured text. It would take a physician about an hour to navigate through it.

Crucial Tools

How can we turn such data into information? Over the past few years, my clinical information-systems team has built what's known as "event-driven medicine" into our applications. These tools help us translate data from events such as changes in medication, patient visits for diagnostic testing, lab results, or newly discovered allergic reactions into actionable wisdom.

Here are three examples:

When a doctor writes a prescription for medication, a query is sent to our regional e-prescribing system to determine the patient's insurance coverage for pharmaceuticals. Based on the answer, we access the appropriate payer-specific list of covered drugs so that all medications are chosen to minimize cost and maximize effectiveness for each patient.