Dell's Harry Greenspun: How to Re-engineer Health Care IT

By Brian T. Horowitz  |  Posted 2010-11-30

Dell's Harry Greenspun: How to Re-engineer Health Care IT

When the Obama administration shaped its health care plan, Dr. Harry Greenspun, Dell's chief medical officer, weighed in with his recommendation as co-chair of a task force on health care IT. Now, many of Greenspun's concepts on health care and IT management appear in the federal HITECH (Health Information Technology for Economic and Clinical Health) Act, as well as the government's meaningful use guidelines on EHRs (electronic health records).

Greenspun is author of the book "Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery," along with Jim Champy, a consultant to Dell and several health care organizations on strategy and operations. 

Before joining Dell, Greenspun served as chief medical officer for Northrop Grumman and is chairman of HIMSS' (Health Information Management Systems Society) Government Relations Roundtable. Greenspun is also a member of the World Economic Forum's Global Health Advisory Board.

A cardiac anesthesiologist, Greenspun holds a B.A. from Harvard University and a medical degree from the University of Maryland. About four years ago, he stopped practicing medicine to focus on corporate health care IT, although he says he still practices on airplanes when needed. named Greenspun one of the Top 10 Healthcare IT Game Changers to Watch, along with U.S. CTO Aneesh Chopra and Dr. David Blumenthal, national coordinator for health information technology.

Greenspun spoke with eWEEK about re-engineering health care with technology, integrating Perot Systems into Dell, as well as the benefits, challenges and pitfalls of sharing health data in the cloud.

What is the message for the health care IT industry in "Reengineering Health Care"? How can health care be re-engineered?

The big message is that technology is really the enabler of improvement in quality and safety and lowering costs. A lot of the larger challenges that organizations face are the cultural issues, of how do you incorporate new technologies into an organization to make them more effective. One of the great opportunities right now is for organizations to really rethink how they approach certain problems as integrated processes and design much more efficient ways to go about getting those things done.

How did you and Jim Champy decide on technology, processes and people as key areas to focus on in the book?

Jim came up with that concept back with his original book, "Reengineering the Corporation." That trio has really served people well. In almost any industry, that's what people talk about-the people, processes and technology issues-because unless you address all three, you're not going to be successful.


Dell's Harry Greenspun: How to Re-engineer Health Care IT

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It's been a little more than a year since Dell announced its acquisition of Perot Systems. How has the integration of Perot affected Dell's health care IT business?

When you combine the legacy of Perot Systems and the legacy of Dell, we're now the largest provider of health IT services globally, which most people don't appreciate. We have literally hundreds of doctors and nurses and other clinicians who have a real depth of experience in improving the quality of health care delivery by using enabling technologies. And so what we're able to do now is combine the reach of legacy Dell with the expertise of legacy Perot to bring a broader range of solutions to a broader range of customers.

What is Dell's strategy as far as IT services in the health care industry?

I think one of the challenges historically the nation has faced-and forget about Dell for a second-is that the big adopters of advanced technologies have been the large academic medical centers, the large practices, etc., but the vast majority of health care is practiced in smaller community hospitals and the average-size physician practice.

With the adoption rates certainly below 20 percent-some people say below 10 percent depending on the market-along with continuing to provide these very advanced services for our large customers, one of the important things is, How do we bring these kinds of advanced technologies to the average kind of practice, the average-size hospital where really the bulk of medicine is practiced right now?

In June Dell announced a deal with Practice Fusion to bring electronic medical records into the cloud. How effective will cloud computing be in allowing health care professionals to access and share medical records?

Cloud computing, I think, will be critical for more widespread adoption. By hosting these applications in the cloud, handling not only the management of these mission-critical applications as well as the privacy and security issues associated with them and the exchange requirements, you're able to remove a lot of that burden from physicians themselves and from the practices and from these very resource-constrained hospitals, so that will be one big factor.

The other issue is that it will also allow those folks to benefit from a lot more services. Along with just the hosting of these applications and the use of health information exchange, they get more sophisticated dashboarding and informatics, benchmarking, and quality comparisons. They can participate in accountable-care organizations by being coordinated in the cloud. It will really open the door to a much higher quality and a more efficient delivery of care.

Dell's Key Health Care IT Offerings

What are the key offerings of Dell Services as far as health care IT?

The services side of Dell is providing the same kind of systems we provided at Perot Systems. We're also doing a lot of work in physician alignment with hospital systems so that Dell can provide physicians with a host of EMR solutions, but also tie back into the hospital systems, so they're able to link up their care much better.

We're working extensively in the health insurance exchange business. We run the Massachusetts connector right now, and obviously in health care reform, the use of health exchanges is going to be a big factor moving forward.

Do you think EHR adoption will be widespread and successful?

I think it will certainly be widespread. The government incentives ... they're certainly not enough to cause everyone to run out and adopt EHRs. But what they are able to do, I believe, is at least get the momentum built to allow a tipping point where we'll get more practices adopting EHRs.

My concern is that as with any rapid adoption of technology, there will be people who do it really well and people who do it poorly.

How can health care companies overcome the privacy and security challenges of health information exchanges?

One of the challenges of privacy and security is it's not the technical issue; it's really the governance issue of how information gets shared. I think the challenge moving forward to the industry is, How can we give appropriately granular control over for consumers of how the information gets shared and under what circumstances will that keep them comfortable-that they're information will remain secure?

We also have to communicate the real benefits of information sharing, that there is a real upside to having their information available wherever they are. Most people understand the value of accessing their financial information wherever they travel. People would be furious if they drove from Washington, D.C., up to Boston for Thanksgiving and couldn't access their money at an ATM there. When you think about it, if you actually got sick up there and wound up in the emergency room, what the real advantages would be of having the doctors in the emergency room access their record.

Even at its most basic level, people are used to making restaurant reservations or buying movie tickets through their phone, and yet they can't make an appointment with their doctor online.


Advising the Obama Administration

You served as co-chair of a task force that advised the Obama administration on how to transform health care through information technology. What are the key ways health care can be transformed using information technology? What recommendations did you make to the government?

The real message was that until we get widespread adoption of electronic health records, all the other things that you're trying to accomplish in health care can't be done.

Look at all the things we're trying to do in terms of expanding access and improving quality and lowering costs. The fundamental underpinning is the widespread adoption of electronic health records and the use of health information exchange.

Did you play a role in advising the administration on the stimulus plan, HITECH, ARRA?

Yes. Much of the recommendations that were in the task force report, many of those wound up being part of-I can't say they were directly part of or listed straight out-but certainly the concepts that were in there, many of those came out in HITECH. So it felt pretty validated there.

We at Perot Systems and Dell have been very active with what's been going on with meaningful use. We provided extensive comments in each of the comment periods. One of the things we suggested was the concept of introducing some flexibility into the meaningful use requirements, and we laid out a model, which is actually quite similar to what ultimately came out in the final rule of the core set and menu set of options to allow some flexibility.

One of the things we had seen in the market was that many organizations were at different levels of adoption. Some were greenfield, some were pretty far along, and ultimately the destination where the government wants everyone is the same place. But the route people would take to get there, depending on where they are now, would be somewhat different, and we needed to build in some flexibility.

What are the pitfalls of transforming health care with technology?

The biggest pitfall is really focusing purely on the technology. I always joke: There are plenty of people who can build a better mousetrap, but unless you understand the mice, you're not going to be successful. These are very complex environments. In how information has been handled historically, literally for the last hundred years since people have been keeping medical records in any formalized sense, it's a lot of legacy to overcome.

Health care is a very conservative industry. It's an appropriate conservatism in the technology piece alone, but at the same, we have lasers, we have robots, we've got a lot of cool stuff in health care right now. It just takes awhile for the culture to say we're actually going to get some widespread adoption of this. And electronic health records will be the same way. It will take awhile, and people will have to change the way they approach some aspects, but they'll find some real improvement.


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