16 Jun WTN interview: Dr. Jeffrey Grossman, CEO UW Medical Foundation
Editor’s Note: Dr. Jeffrey Grossman, president and CEO of the University of Wisconsin Medical Foundation and associate dean for clinical affairs for UW Medical School was the kick-off speaker at the Digital Healthcare Conference 2004. In this interview with WTN, Dr. Grossman discusses how advances in technology are creating huge volumes of data but, at the same time a “Knowledge Gap” between what we know and what we do. Dr. Grossman is board certified in internal medicine, pulmonary disease and critical care medicine, and maintains his practice in pulmonary and critical care medicine.
“The gap between what we know and what we do”
Wisconsin Technology Network: How would you describe the intersection of technology and health care?
Dr. Jeffrey Grossman: Our knowledge of medicine is growing at a phenomenal rate. Rates that far outstrip our individual or collective abilities to deliver that knowledge at the physician- patient interface. I describe two curves: one of medical knowledge, which is rocketing, and the other is how we organize that knowledge and how we deliver it. And that is how I see it is an extremely flat curve.
I am seeing an increasing gap between what we know and what we do.
To the extent that health care is about serving our patients, there is certain degree of self-satisfaction with health care amongst scientists and providers that is probably not well deserved at this point. This is because we have not effectively translated what we know into what we do.
You cannot talk about health care as a single paradigm. I can conceptualize two or three groups of populations of patients. The one place that medicine has become increasingly effective and where people can feel quite satisfied, is in dealing with episodic acute illnesses, where a single or small set of interventions is required. We are now very good at recognizing those illnesses and intervening to get people back on course.
That represents the probably most dramatic things we do in medicine and is the sort of thing that makes the news in sound bites, but it doesn’t represent the bulk of medicine, it is the tip of the iceberg.
WTN: What happens when medical records are combined with medical images, and physicians will have terabytes if not pedabytes of content to synthesize?
Grossman: I am concerned about that occurring. People are conceptualizing electronic medical records and PACS systems and data storage as the next the big thing. We have to really consider just how big it is. What we are doing is making an attempt, which presumably will be successful, at recapitulating what we do now, except in electronic form versus a confused paper and hard copy form. That is a step, but I would submit it is a very small step and what we really need is integration of that data into knowledge.
WTN: Is it about getting the right knowledge, in the right context, to the right people, at the right time when making decisions.
Grossman: Yes it is really that sort of gap!
One counter-intuitive way at looking at this is describing the need to for technology to make medicine human again. Right now, I think physicians are so overwhelmed with the choices available to them; the data available to them, that most important human interface with a vulnerable patient is usurped.
If you think about electronic medical records, the typical sardonic look at electronic medical records is the physician sitting in the office, in front of his computer typing away, while the patient is sitting off in a corner, without any eye contact and with verbal contact only to fill in the spaces. That is not why young people go into medicine. It’s not what patients need.
And even as we move towards newer and presumably better ways of using information technology, where are not usually fulfilling our compact with patients.
WTN: What are the barriers to adoption of information technology to medicine today?
Grossman: There are a bunch of barriers; one of those is the embedded barrier to change in any organization or industry. That is the sense that you are doing well enough right now, and a resistance to change things in an incremental way, for fear of destabilizing what is already going reasonable well.
Some people have pointed that change requires some sense of urgency, that things not going well, and that is the best context in which to bring change. That is not widely held view in organized medicine, for which for the most part congratulates itself for things going reasonable well. I think it [organized medicine] falsely congratulates itself in my book. I think this is an issue.
If you look at individual physicians, especially those that are sub-specialty trained, who are highly focused, they feel extremely competent in their areas, and it is that very focus that makes them competent, but also excludes them from seeing the bigger picture of how we are failing in a broader way.
So there is not much impetus for change at the individual level, certainly there is probably much more impetus at the societal level, but it does not translate down to individual physicians.
The other overwhelming issue here is money. Who is going to make the investment in this whole process change? I think we have a number of problems here. First of all we have the cost of medical care that already exceeds other highly civilized and sophisticated countries by over two times. We are already spending more money than we have on medical care. Information technology has not been part of the business plan of most healthcare providers. Hospitals have typically lagged in extending information technology. Independent physicians typically feel that they have no capital to spend on this. I think there is a diffusion of responsibility for this piece of healthcare delivery.
WTN: What is your perspective on recent government efforts to help accelerate deployment of electronic medical records systems?
Grossman: My personal belief that this is all tied together with the concepts of universal healthcare, which I believe we need, along a with a more organized and cogent payer system. This is certainly part of the problem. But, what I think we are hearing at the moment are largely un-funded mandates. Both physicians and hospitals will respond that while there is increasing pressure being brought to bear to organize around these concepts of information technology, that at the same time funds are being drastically cut back to support other functions of medical care. So there is simply no capital for this.
What I think is being talked about will work fine for some pilot projects and demonstration products, but generalizing that kind of change is going to be a massive undertaking and one that nobody seems ready to fund at this point.
WTN: What are the technology obstacles that IT vendors need to overcome?
Grossman: There are barriers to change in terms of current technology. I think there has been a peculiar lack of functional off-the-shelf software that can do the sorts of things that we all insist need to be done. This industry has not progressed very quickly, it has been an industry that has flourished by putting together pieces and hardware and software, as companies have consolidated, which don’t necessarily fit very well into systems and there is a litany of stories of unsatisfied customers. People who are buying things at large expense, that simply don’t work. In fact, there is a significant backlash right now going in this country. Hospitals and physicians are saying, “wait a minute,” this is really not ready for the general consumer, and we do not want to be on the forefront of developing this.
WTN: Can you explain the debate between best of breed versus integrated solutions?
Grossman: There is a good argument of best of breed versus integrated solutions. One of the issues is that it is hard to put best of breeds together. The interfaces are terrible, and I think there is too much vaporware and false advertising about integrated systems which simply as not as functional as they have been portrayed to be.
What’s is happening is that even those institutions that are willing to make the investment, and go in to it with their eyes open, are then winding up with so much internal turmoil and strife amongst physicians and administrators, that we are now hearing those stories increase as well. In essence, this is a matter of people of wanting to and often trying to do the right thing, and simply not being able to do it!