Will HITECH Lead to Innovation? The Continuing Cat/Dog Dialogue

Will the recently passed HITECH legislation — the federal stimulus funding for health IT — encourage innovation?  or will it lock in outdated electronic health record (EHR) technology?

It’s a mixed bag — HITECH legislation  is both dog-like (innovative) and catlike (protecting incumbents).  I’ll refresh your memory below on more specific definitions of cats and dogs.

Among many other reasons, HITECH is dog-like primarily because it has ended the question of WHETHER the U.S. is really serious about health IT reform.  HITECH spells out clear policy goals working toward interoperable health IT and dedicates an initial $19B in federal stimulus funds to begin the work. HITECH begins to create an environment for innovation in health care reform.

There are many open questions as to HOW best to go about this — how to spend the federal stimulus funds in ways that encourage innovation.


On balance, HITECH favors cats by about 60/40.


There are many reasons, but the single most catlike feature of HITECH is that it provides incentives for physicians and hospitals to acquire and implement EHRs  — but only EHRs.

How does HITECH resolve the issue of direct funding for a range of potentially useful health IT?

Certified EHR Technology: $17 Billion

Everything else: $0

While I understand the importance of EHRs, there are many other disruptive innovations and technologies that are left out.  For example, the Patient Centered Primary Care Collaborative recently described the range of technologies that will be necessary to fully implement the Patient Centered Medical Home:

Definition of Health Information Technology and Exchange (HIT&E):  Any computer hardware, software, electronic service, and/or related technologies that provide or enhance the capabilities of the patient centered medical home across the community . These may be installed solutions, service solutions, or solutions provided in some way by a third party (health plan, community organization, RHIO, etc) and could include – but are not limited to – EMRs, PHRs, EHRs, interactive web portals, patient or population registries, e-prescribing software, communication platforms such as secure e-mail, online scheduling, connectivity to home monitoring systems, data aggregation and reporting services, electronic decision support tools, and other online or web services that accept and process personal health data for the purpose of supporting better health care decisions.

EHRs are just one piece of the solution.

A summary of the cat and dog POV

Prior to the passage of HITECH, Matthew Holt published a collection of articles of articles in The Health Care Blog.  The articles provided advice and suggestions about the best ways to spend federal Health IT stimulus funding. Authors included national IT leaders, knowledgeable clinicians, and industry executives. I’ve written about this previously , but the cat/dog dialogue is even more relevant now that HITECH is law.

In a post entitled “— Cats & dogs: Can we find unity on health care IT change? , Matthew boiled down the collection of articles into two schools of thought, which he coined as the cat POV and the dog POV:

CATS: Although they discuss incentives (and most of the $20 billion will probably be aligned with some P4P measures), the cats’ (Leavitt/Halamka/Kolodner view is closer to the thought that if you get the appropriate clinical technology (essentially in-patient and outpatient EMRs) into the hands of clinicians, then they’ll figure out what to do with it, and eventually the government can pay them according to how well they do it.

DOGS: Outcomes vs. technology: The Kibbe/Klepper/Peters/Neupert/Bush faction (the dogs) assumes that we need to change the incentives in the system, and then IT will naturally follow—and the current embryonic decision support systems will flourish quickly. But that current clinical systems aren’t good enough to invest in mostly because current results from EMR installations are very disappointing.

Here’s an elaboration and summary of the difference in the cat vs. dog POV (click on the graphic to see a larger version).




The start of a series: promoting disruptive innovation in health IT reform

As I’ve stated previously, I’m a dog.

This article is the first in an ongoing series. The HITECH legislation is complex and open ended.  The dogs of the world need to have their barks heard.

Future posts in the series will:

  • Provide suggestions and advice how disruptive innovators (dogs) can develop successful technologies and business models under HITECH
  • Provide input how to implement HITECH policies and regulations to support innovation
  • Suggest future legislative modifications to HITECH — national health reform legislation, HITECH 2, and others

Remember that harmony is possible

The passage of HITECH legislation takes a lot of the pre-existing tension out of the cat/dog relationship.

Cats and dogs now are ultimately working toward the same ends…how best to improve quality of patient care and reduce costs through the adoption and use of information technology. We have many common interests and goals.


6 thoughts on “Will HITECH Lead to Innovation? The Continuing Cat/Dog Dialogue

  1. How does HITECH resolve the issue of direct funding for a range of potentially useful health IT?
    Certified EHR Technology: $17 Billion
    Everything else: $0

    How does this work out to 60/40?
    Looks to me like 100% cats. This isn’t going to do anything for the kind of innovation we need to improve the quality and efficiency of health care.
    It’s the same as the rest of our health care system. Throw more money into the same system. Are they expecting something different to happen? The usual result is the cost of health care increases, corporations get rich and doctors have to work harder.
    The information is only useful if it uses standards and can be communicated. There is no money for data exchange standards and implementation.

  2. In my native England “raining cats & dogs” refers to heavy rain. We certainly have some haevy rain in HC & IT right now. Vince, as always you are on the ball. What the US Healthcare industry & HC IT really need is new thinking about how to harness technology to improve efficiency & effectiveness in providing diagnosis, treatment and payment processing methods, not just more $ thrown at the mess we have today.

  3. Mark, I understand your point and agree that from what’s written so far you might conclude that HITECH is 100% cat-like.

    In future posts of the series, I’ll list aspects of HITECH that are reasons for canine optimism.

    Peter, thanks for your good words. I’ll hope you continue to contribute — this should be just the start of an important dialogue about innovation.


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  6. Awesome post!

    I’m really looking forward to your future post with suggestions and advice how disruptive innovators (dogs) can develop successful technologies and business models under HITECH.

    Thanks again!

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