Ranch Kimball and John Halamka at HBS

by Sarah Cortes

Another early morning at the sunny and elegant Spangler Center at Harvard Business School finds over 100 leaders of industry preparing for a double feature from two health care movers and shakers. First on the program is the well-known Ranch Kimball, President and CEO of Joslin Diabetes Center and former Secretary of Economic Development under Governor Mitt Romney. As if Kimball weren't enough, John Halamka, pictured left playing the Japanese flute, will be speaking. CIO of Harvard Medical School, among many other roles, posts and responsibilities, this high-profile medical technologist is one of the most sought-after thinkers and speakers in the world of health information technology("HIT"). Although unclear at first why these two are double-billed, it soon becomes apparent.

Kimball runs through a deck of slides with dizzying speed and stunning clarity of message. Russ Vandenpool, a board member of HBSAB, the sponsor of the event, summed it up: "Kimball takes a page directly from Michael Porter's book on competition by applying focus on quality and defect reduction to health care delivery." Although only at Joslin since 2007, Kimball explains he has retooled the center based on lessons from Toyota's famous revolution - focusing on quality of care delivery up front to significantly reduce cost and improve patient quality of life over time. Kimball shows us how tuning and focusing on eight specific service delivery points with patients early on reduces the need for dialysis and surgery later. Some pretty clear slides prove this, he explains, where the purple Joslin cost bar is clearly shorter than the green cost bar for all other providers, as everyone can plainly see for the microsecond it flashes on the screen. It's just long enough to make the point effectively. Complete economy of Kimball's message and our time.

Next up is Halamka, who we look forward to from our acquaintance with his well-regarded daily blog, "Life as a Healthcare CIO." On this topic, electronic health records ("EHR") and electronic medical records ("EMR") are core concepts. Halamka apprises us how BIDMC coordinates with Joslin by sharing medical records, a technical feat in the world of health care, we come to understand. According to Kimball, pictured right, Joslin went to all-EMR seven years ago and was, he believes, the first Harvard hospital to do so. The disarming interchange between Kimball and Halamka informs us how closely these two coordinate professionally. An insight into a human success factor behind technical coordination?

Halamka's part of the program soon conveys how far from simple is his world of medical computing. Halamka's slides reflect a close watch on the Washington pulse, including a HIT Policy Committee, an HIT Standards Committee, and "Regional HIT extension centers." The first of these, the HIT Policy Committee, is apparently focused on "meaningful use," of electronic records, an elusive concept on which Capital Hill is still wandering in the wilderness. $19 billion in federal funds lie in the balance, it seems, available to spend and waiting for consensus on the best way to spend it. Only 2% of hospitals, we learn from Halamka, are currently on-line with EHR, and these funds are intended to encourage and allow the rest to get there as soon as possible. The government has announced it will divide the $19 billion among doctors, providing each with $44,000 to go into electronic records in 2011. Doctors can qualify for reimbursement if they show "meaningful use," whatever that is. As best as anyone can tell, this relates in some way to certification of the electronic method and software that doctors select against some technical standard. Guidance from HHS is expected to be available by the end of the year.

Because state law pre-empts HIPAA, Halamka notes there are, in effect, "50 privacy policies," in the sense that the patchwork of individual state policies effectively prevents information-sharing, quite apart from technical challenges. "Privacy has been protected differently in each locality," notes Halamka.

He hopes policymakers can do away with the current system whereby, after seeing a patient, the doctor calls a phone number on the patient's insurance card and "gets to argue with a high-school educated triage clerk about the appropriate diagnosis." Halamka's cynical humor conveys a deep-seated frustration with the current system, coexisting curiously along with what seems like good-natured optimism that we nevertheless can and should improve health care.

Halamka flashes a detailed slide on the data interoperability capability for all providers in Massachusetts, called the "MA-Share Appliance." Apparently this is opensource software, "built on a common messaging gateway," by which health care providers can communicate with each other to improve quality of patient care delivery.

He shares that he was the fourth human to have his genome mapped as a way of illustrating the rapid way the cost of such sequencing is coming down, from $350 million for the first human (which might include all sunk costs to that date. Or the special carrying case), to $100 million for the second, $100,000 for the third, and his cost only $10,000 for genome sequencing.

Halamka also shares that his annual budget is $30 million, which is 1.8% of revenue, always an interesting data point for IT professionals

Kimball, scheduled tightly, rushes off apologetically after Q&A, while Halamka lingers graciously a few minutes after the meeting ends as a crowd surrounds him, eager for every word with this oft-quoted, pace-setting CIO.

copyright 2009 Sarah Cortes