Systems broken, not providers

The coming changes in in healthcare, both here in Vermont and nationally, are an indictment of a broken and inefficient system. The changes are not an indictment of individual providers, their compassion, the quality of care they provide individual patients, or the hard work they do every day.

I am currently working with a community physician who uses one EHR vendor. He wants to get records from a local hospital - on a different computer system - into his EHR. Although technically possible, the task is blocked by many social, political, and economic boulders. The data gridlock is not the fault of any person, but the result of complex systems. Yes - we
could be doing better. No - this does not mean we are failing.

Another colleague recently listened to a talk about #PCMH. She was offended at the idea that an administrator felt she was not already providing quality, comprehensive care. Somehow she took it personally. This provider-centric view misses the point. It's not about us as healthcare providers, not about our dedication, not about our work ethic. Trust me, a family physician in Vermont is not in the game for money or glory. Got it. But we can't be such martyrs that we are unable to measure what we deliver and improve how we deliver care.
The deal with #PCMH is not the provider, it's the standardization of all providers. It's about getting the system so finely tuned that lab results always get back to the provider before the next office visit, that every diabetic patient has an A1C on time, that all smokers have a pneumonia vaccine. These goals cannot be accomplished by scattered providers in their clinics trying hard. The systems have to drive the care.
For many of our quality metrics, we consider that we are doing well with 50% adherence to a standard. If we are really on our game, we might hit 90% of goal. Would we celebrate that as success in banking?
Value in healthcare is high quality at low cost. Value happens only with standardization. Standardization happens only with measurement. Measurement happens only with #EHR. This is the fundamental task of #PCMH. Really, it is not about the provider. It isn't really about the patient. It's about the system.