The RAND Corporation has just come out with a new report on electronic health records and reversed its 2005 prediction that they would help save billions of dollars. Now it says electronic health records might actually cost more than paper. What went wrong?
Framing. One of the most important skills in business and in our own personal lives is how we design our engagements with the world. We have dozens of different kinds of engagements every day and each is different. How we interact with friends, colleagues, children, bosses, doctors, parents varies dramatically. In the past, our engagements were limited in number and predictable. We were born into most of them. Now, thanks to social media technologies, we can actually create thousands of new engagements. We need to be aware of them and design them to get the outcomes we prefer. We need to frame those engagements to our benefit.
That has not happened with electronic health records. RAND and the federal government wanted electronic health records to do two things–lower costs and bring better health benefits to individuals by giving them more data. The problem was that the market incentive for the private companies writing the software was to use electronic records to boost the efficiency of billing by hospitals and physicians to raise their profits and income.That led to higher, not lower costs.
The engagement that was framed and designed to improve was the financial one between provider and consumer. The engagement that needed to be framed and improved by electronic files was the flow of medical data among providers and between providers and consumers. This most probably could save big sums of money and certainly help people in their own medical care.
In creating new forms of relationships and organizations, framing the right engagement is key. We still have time to do that with electronic medical records.