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Barry Chaiken


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The Road to RHIT

“I have curiosity. I’m always looking for a paradox, or information that adds to or contradicts my beliefs. . . . I want to be governed by people who are much smarter than I am.”

     —John Cleese

When I began my medical career as a medical detective at the Centers for Disease Control more than twenty-five years ago, my technology tools were a stethoscope and a blood pressure cuff. Our information came primarily from paper reports and attending conferences. Computers were for the back-office accounting and management staff, not for doctors.

Look at the progress we have made.

Or have we?

Of course we have. As the famed science-fiction author Arthur C. Clarke, who penned the novel 2001: A Space Odyssey, said so well, “Any sufficiently advanced technology is indistinguishable from magic.” It would be interesting to know just how many lives we have saved in modern healthcare because we were able to employ advanced technology.

My interest in the magic of technology has paralleled my medical pursuits. They were the two hands washing each other. Yet over the years I saw healthcare failing to sufficiently take advantage of technology. We seemed to get to a place where the prevailing attitude was “good enough” use of high tech. That was no surprise; it was a fact established in the late 1980s that humans would recall no more than seven functions of a technology tool, for example how to save, copy, footnote, or change from sum to count. Those few who mastered more were called “power users.”

This book is about how practicing clinicians all ought to become power users. We must raise our sights to how much more we can achieve through expanding our technological knowledge and skills in the practice of healthcare. We are not doing badly; witness our continuing recovery from the 2020 pandemic. But there is so much more we could be doing if we were only to deploy all the technological tools at our disposal.

Years ago, I came up with a name for this quantum movement forward in our profession: revolutionary healthcare. I realized the best—perhaps the only—way to take the necessary next steps in delivering health alongside treating symptoms was with more technology. I began referring to this solution as healthcare information technology (HIT), to which I added the term revolutionary, hence the use of the term revolutionary technology in the subtitle of this book.

To that phrase I honed and refined the following description:

Revolutionary Healthcare Information Technology (RHIT) offers clinicians, researchers, and administrators immensely powerful tools to drive clinical and administrative processes to deliver high-quality, safe, accessible, and investment-responsible medical outcomes.

Note that I include administrators in my definition. We need the admin people to keep our business and our partnerships with payers and governmental agencies intact and thriving. There may be misunderstandings and some friction at times, but the clinical-administrative relationship must be cared for as rigorously as the clinician-patient relationship.

The RHIT platform. From this platform, if I may call it that, over time I defined the six main concerns I believe all of us in healthcare—both clinicians and administrators—must focus on for constant improvement.

  1. More time with the patient. This is job number one. I call it the human touch and it should never be left to an indifferent payer to determine the amount of time or care spent with patients.
  2. Computers have no “bedside manner.” They are essential, but their purpose is to support healthcare. Tasks computers are good at should be handled by computers; patient care is what doctors and nurses are best at, and should be respected first and foremost.
  3. Workflows are how each of us gets our jobs done. Processes guide all of our workflows toward our institutional objective. When clinical and administrative workflows are in sync, we have effective, efficient, business process management.
  4. Good business process management is always the result of implementing healthcare information technology.
  5. Better integration of HIT makes better outcomes more consistently possible.
  6. Revolutionary healthcare information technology (RHIT) uses analytics to improve processes, facilitates evidence-based medicine at the point of care, and affirms the workflows to guide clinicians to the best outcomes.

Over time I developed a model and a visualization of this, which I call the Chaiken RHIT Methodology. It is presented in Chapter 5 and is integrated into discussions throughout the book. The Chaiken RHIT Methodology uses analytics to assess pertinent data and guide the patient to a successful outcome. Metrics assigned to a particular process allow us to evaluate, learn from, and then iterate meaningful change within that process for the highest quality of care and a repurposed focus on successful outcomes. I believe this emphasis creates more efficient processes and workflows and leads to a sound investment, which we all believe is necessary for healthcare to improve.

Such a system enhances the essence of healthcare. It is the product of an optimistic, empowering, positive, people-centered business model that puts the relationship between the clinicians and the patients front and center, assuring trust, with the solid backing and support from essential administrative services.

Navigating the Code intends to demonstrate that these goals and objectives are achievable without tossing out the existing system, but rather by developing some new ways of thinking about workflows and processes.

How Navigating the Code Is Structured

Navigating the Code consists of five Parts:

Part I: Thinking about Healthcare (Chapters 1 through 4) provides an overview of today’s healthcare environment.

Part II: Transforming Today’s Healthcare with Revolutionary HIT (Chapters 5 through 8) disseminates the business aspects of healthcare with an emphasis on its information technology and the need to revolutionize it in the quest for an overall transformation of our business operations.

Part III: Applied Change Management (Chapters 9 through 12) begins with a basic introduction to personal and institutional change, followed by in-depth explorations of change management for IT, workflow, clinicians, and, last but not least, patients.

Part IV: Revolutionary HIT (Chapters 13 through 17) returns to the key theme of the book, revolutionary healthcare information technology. The degree of change needed to restructure healthcare cannot be accomplished without a revolution throughout the organization; these five chapters explain how and why in detail.

Part V: True Twenty-First-Century Healthcare (Chapters 18 and 19) sums up by stating we have not achieved any significant changes to our business in the twenty-first century, and goes on to explain how we can begin making the decisions and taking the necessary steps to achieve transformative healthcare.

Chapters have been written at a length appropriate for reading in a single sitting. I encourage you to highlight, underline, and otherwise annotate as you read to frame questions and enhance your understanding.

Throughout the book, you will find two features:

  • Bedside Consult, exemplary anecdotes apropos of the chapter theme, and
  • The RHIT Interview, interviews I have personally conducted with healthcare professionals from all around the world who share many differing perspectives on healthcare.

Both are intended to give you a perspective that I alone could not. I hope they enhance your interest in learning what is possible for the future of healthcare.