Triple Constraints Health Care Informatics and How

Triple Constraints

Health care informatics and how that field interacts and is affected by triple constraints is the subject of this brief report. Further complicating this paradigm is thre passage and enforcement of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Specifically, the meaningful use objectives that are mandated by that act have simply added more hoops for informatics project personnel to jump through. While the HITECH act and the general topic of triple constraints has made the proverbial playing field more treacherous, it is possible to navigate the project landmine that exist and the requirements posed are not without merit and purpose in the grand scheme of things.

Questions Answered

Since the HITECH Act has been the bigger and more recent development relative to triple constraints, that will be covered first. There are four initial definitions and parameters for meaningful use that are required and five more that are desired over the long haul. The four that are non-optional in the views of the United States government and the "spirit" of the act are to improve quality/safety/efficiency and reduce health disparities, engage patients and families, improve care coordination and maintain privacy and security of patient health information. The more conceptual and long-term goals stated on the HealthIT.gov website are better overall clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals and more robust research data on health systems (HealthIT.gov, 2014).

In the end, this all sounds good but does put a bit more pressure on the overall triple constraints of scope, time and cost. One of the major pressure points brought on by "meaningful use" is the subject of healthcare disparities, which references demographics and parts of society that face more dire health outcomes and projections due to problems such as access to healthcare, propensity for certain disorders and diseases to occur based on race, age and gender and so on. While health care information teams do have a role to play on this subject, there is (in the end) not a whole lot that can be done just by the informatics team because the factors that cause healthcare disparities are complex and often have little to do to nothing to do with healthcare information teams or hospitals in particular as the rising costs of health care and societal inequity is not something that is caused by hospitals, at least not unilaterally. For example, if systemic healthcare costs are so out of whack that a challenged minority will not go to a doctor until they are truly in bad shape and then they go to an emergency room with no insurance, the hospital still has to treat the patient and track their progress irrespective of why they don't have healthcare coverage or access to doctors and those problems have more to do with more general and/or other factors that have nothing to do with the hospital's IT system (KFF, 2014)(HIMSS, 2014).

However, there is a way to have the best results and outcome for all involved. However, there is really "quadruple" constraints, rather than triple. The parameters of a project must fulfill four general precepts, that being that the scope and reach of the project is defined, that the time horizon in which to complete the project is defined, that the cost of doing the changes is defined and that there is no preventable negative impact to victims of health disparities as a result of the project. In short, if there is a benefit to undergoing a healthcare informatics project, it should benefit all patients and practitioners equally. If there is a disparity in outcomes from a project, it has to be ensured that it's because of societal or other factors that are not controllable by the project members. Disparate outcomes do not mean disparate treatment for what is controllable but it has to be verified in each and every case that the hospital is doing all their due diligence. For example, an initiative that involves customer access and participation online must be regulated by the fact that economically disadvantaged people do not have the best track record of being able to afford to consistently access online resources and many of these disadvantaged people are minorities. Even so, having the option there is fine as long as items that assist the poor and needy are not sacrificed in favor of that. Obviously, the records in a system are faceless to most IT professionals as they are not on the front lines of care. Even so, equity of outcomes, while not usually possible, should be strived for as much as possible and the information technology resources should be wielded so that the scope, time and cost dimensions are not skewed in favor of the rich and powerful but instead become the proverbial tide that lifts all boats. This can be a tall order but it can be pulled off.