It has long been said by historians and pundits that you have to wait twenty years after a president is out of office before you can begin to accurately assess the impact of his term of office.  Unfortunately, I have now lived long enough that I am beginning to appreciate this point. 

On a recent vacation, I listened to Doris Kearns Goodwin's great book, 'Team of Rivals,' the story of Abraham Lincoln and his cabinet.  That even now we find new information shedding more light on Lincoln does encourage us, at least from time to time, to take a long view.

This idea prompted me to think about the nascent physician IT industry that occupies us now.  Hey, I was driving across Kansas when I was listening to 'Team of Rivals' so my mind may have wandered a bit.    

When things are so new that there is no 'long view' yet to take, what do you do?  Try to see if there are some other lessons that you can learn from parallel situations.

I had the fortune to spend my early career at Andersen Consulting, now Accenture, right at the time the information technology business began to explode.  It was a go-go time, reminiscent of how things seem in healthcare right now.  Firms such as ours were growing at the speed of heat, helping our clients in manufacturing, distribution, retail and financial services install these massive software products that were going to change their world.

In the 1960's, inventory control systems, particularly in manufacturing, were the rage.  It was really one of the first large scale commercial deployments of this new computer technology.  Manufacturing Resource Planning (MRP), the systems were called.   In the 1980's, we got MRP II when the software began to integrate financial information with the manufacturing data. 

The universal force of TLAs (Three Letter Acronyms) took over and MRP II morphed into ERP, swapping the M of manufacturing for an E, as in 'enterprise.'  Now the system was organization wide, uniting and integrating data from all over the company. The Sales department did not want to use software that said 'manufacturing.'  How pedestrian.

The IT boom was on.

Money flowed at unimaginable speeds.  Chief Information Officers went from living in the basement, trying to keep the big mainframe running, to the executive suite.  The nerds got invited to the big party and began to wear much better clothes.  Top college grads went into the IT business instead of banking.

Then like that rude, but honest little kid at the Thanksgiving dinner who asks, out loud, why Uncle Bob walks around in his underwear and no one seems to notice, people began asking about the payoff from the billions being spent on this IT thing. 

As we entered the 1990's, several academic types published papers pointing out that U.S. worker productivity actually declined, even as companies were spending fortunes on new information systems.  Robert Solow, a Nobel Laureate in Economics, seemed to sum up the growing suspicion when he said, 'We see computers everywhere except in the productivity statistics.'

Ouch.

And double ouch if you were standing in front of the executive team of a potential client, asking them to spend several million dollars on one of these new fangled ERP systems that would make everything just hunky dory, and then the curmudgeonly CFO tosses copies of one of these studies to everyone at the table and asks you to respond.

Quietly, privately, IT practitioners and peddlers began to ask if there were, in fact, any tangible financial benefits from these investments.  In the midst of the frenetic pace, there was at least a little soul searching.

Fast forward to today.

We've been beset, no, downright obsessed with economic news for the past two years now.  I guess a long, deep recession will do that.  While we pour through any data that might help us understand the future, there is really only one number that matters and that is 'jobs.'  Where are the jobs and when will they come back?

But lost in the bad employment news is an interesting little fact, one that changes the perspective on IT investments from that of 20 years ago.

Companies all over the world have seen dramatic increases in worker productivity.  They are getting the same or more work done without all of those people who are not working right now.

How did that happen?

Much of the gains in productivity have to be attributed to information technology.  There is both factual and anecdotal evidence. 

Somewhere between a third and a half of all capital investment in the US is for information technology.  Manufacturing, where this whole story started, has been investing in IT longer than most any sector, and not surprisingly, saw its productivity (output per person) grow almost 60% faster over the past 20 years than the economy as a whole.

This is not a commentary on the right or wrong of this situation.  If you are unemployed and having trouble finding work, the fact that, 20 years later, the investments in IT are finally paying off in productivity gains probably does not provide much solace, much less help with the grocery bill.

Yet, this is a major story lost in the wash of the economic news of the past two years.

I am not an economist, and I surely would not attempt to draw too many half-baked conclusions from my limited research for this posting, but as a healthcare guy, finding myself again right at the beginning stage of an IT investment boom, I would suggest there are some long view lessons we can learn from our industry brethren who went 20-40 years before us.

I don't think the healthcare IT dreamers are wrong, except when they get too aggressive on the time frame. 

The idea that healthcare IT can, and will, lower costs makes too much logical sense. 

We're an information intensive industry that processes much of our information in some of the most inefficient ways imaginable.  If fax machine salesmen still have your industry targeted as a high priority, something is wrong.

Our information is exceedingly complex, a problem that IT is well suited to solve.  We have around 13,000 diagnoses and a very, very, very large number of potential combinations of symptoms that indicate each.  You can't tell me there could not be an occasional role for some complex algorithms running on a super fast processor that would help a physician decide what is wrong with the patient.

As has been well documented, our information limitations and failures cost a lot of money in repeat work and the wrong care being delivered.

No, I am a believer.  If manufacturing and banking and retail and publishing can realize dramatic productivity gains by using complex, interconnected information systems, then so can we.

When you get back to the timeframe issue, however, things need to get a little more real.

Look at that manufacturing story again.  Heavy investments in the 1980's had the skeptics howling in the 1990's.  It took a long time for the results to show up.

What does that mean for us?

First, the good news.

At least a large part of the long cycle between investments made and benefits realized by industry was due to waiting on a lot of the underlying infrastructure to mature.  As late comers to this party, we jump into this fray with the PC and the Internet and a lot of foundational technology fully in place and very mature.  So we can go faster.

Also, we have a lot more IT talent and accumulated wisdom to draw from than we did in 1980.  That lets us just skip a lot of mistakes made by the early pioneers.

However, we still have our challenges.  Which means the lag between costs and benefits will still be material.

I am not a data architect, so I can't say definitely if our data is more complicated than that of other industries, but I'd take that bet.  Heck, we are still having trouble agreeing on standards for identifying patients.  What happens when we really start focusing on clinical data?

We have a big structural problem as well, particularly in the corner of healthcare that is the focus of this space.  Though changing, physicians still mostly practice in small organizations.  Most do not have the IT talent necessary to make their IT work. 

I am sure the user interface and workflow issues in every industry are challenging.  But think about our work for a second.  I remember being with a group of physicians when many of them saw their first EHR demo.  One commented about how complicated it all seemed.  Another agreed, but asked him if there was any function that he saw on the screen that he did not need, anything that he was not already doing in some other form.  No, he conceded, there was nothing about the EHR that was 'adding' new stuff.  It was just that the work is complicated and that the system reflected that.

More critically, access to the necessary capital, especially if there is a long wait between writing the hardware and software vendor checks and realizing the positive cash flow benefits, is a major barrier.  A four doctor partnership just does not have the financing options of a Fortune 500 company.

Finally, don't forget all of our other little idiosyncratic features.  We're mostly local; we're clinically specialized all over the place; we're tied to varying degrees to hospital partners that may or may not have the same objectives that we do; we have this little thing called 'third party payers' that complicate everything; and oh yes, the federal government is here and wants to help.

But be encouraged by the 20 year view.

We're in the investing years now.  And the wags are out in force, questioning the value of these new fangled EHRs and all of the money being spent.  To be sure, there are some data that support their position, especially right now, raising doubts for those contemplating whether or not to jump in.

But aren't you glad that you don't have to go into the bank every time you want to get $100 in cash?