Comments on the idea of "shared" IT solutions

Jennifer Christian MD

My two colleagues and I have briefly discussed the idea and decided to recommend AGAINST the 8 states in Phase I of RETAIN trying to share an IT system for capturing data and supporting project workflow.   


(The three of us wrote the proposal that OMB staff has acknowledged inspired and provided a vision for RETAIN.  Kim Burton is in the UK and intimately familiar with the Fit For Work Service there;  Tom Wickizer is the health systems / economics researcher who has steadily evaluated Washington state’s COHE program since its inception.  These two programs served as models for our recommendations for a Community-Focused Health & Work Service)


In theory, shared IT systems would make the evaluation of the project much easier but ….. here are my personal views on why it’s not a good idea now.  


By intention RETAIN is not going to be homogeneous.  The Feds are soliciting proposals from many states in order to encourage a variety of creative solutions.  They want to be able to compare how well different approaches work out.  So the 8 states in Phase I are each going to have their own unique project design and will be implementing it in different local circumstances with different types of organizational players.  In fact, diverting time and energy away from designing and delivering services to developing requirements for and then selecting, buying, modifying, installing, and learning new software to support a 9 month pilot seems kinda nuts to me.   


The overall success of the RETAIN service depends on getting the various professionals to actually collaborate in actual cases.   Since the pilot program will be a low volume endeavor, we must maximize the convenience for the local players so they cooperate!  In order to avoid doing a lot of extra work and going crazy, most them will no doubt greatly prefer trying to work within and make modifications to their own systems – or even do crude workarounds -- writing emails and keeping excel spreadsheets and sending stuff back and forth.  


The report of the UK’s (failed mothballed) experiment with a Fit For Work Service was just released yesterday.   Question:  Why was the rate at which they received referrals from Scottish physicians was MUCH higher than the rate at which they received them from English or Welsh physicians?  Answer:  In Scotland, the referral process was imbedded in the usual medical referral part of the electronic system the doctors use all the time every day.   In the other two countries, the docs had to do something extra -- go to an on-line portal and hand enter a lot of demographic data.  That severely reduced the referral rate.  And it was low referral rates that scuttled the whole program (although there were many other factors that contributed to that problem.)  We’re analyzing the report in more detail and will be sharing other important learnings with you shortly.


Although an attempt to prematurely force standardization via a single IT solution seems unappealing, it is also true that data heterogeneity is going to drive the RETAIN evaluators wild.   It may even imperil their ability to determine whether the RETAIN project as a whole was effective – which is the point of the whole darned thing!   So one of my first suggestions is that immediately after the starting gun sounds, the 8 states should all get together with the evaluators and Technical Assistance team, look at and compare everyone’s plans, and see how much can be harmonized among them!


I hope these ideas are helpful.



Jennifer Christian, MD, MPH

President / Chief Medical Officer

Webility Corporation

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Wayland, MA 01778

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Email: jennifer.christian@...