For Eytan Dallal, the best solution might not always be a technology solution—especially when the temptation to add tech runs high.
As vice president of IT at Land of Lincoln Health, he captains his organization’s technological initiatives but always encourages his colleagues to seek non-IT solutions first. “A primary instinct among many of my colleagues is to find an IT solution, but my experience has been—from an engineering as well as an executive approach—that you have to first consider non-IT solutions to solve business problems,” Dallal says. “Usually, those revolve around management, process, training, and strategic thinking instead of applying technology.”
Naturally, vendors love to emphasize the problem-solving, cost-saving, revenue-boosting capabilities of their tech solutions, but Dallal remains cautious and deliberative when committing to a technology project. “I treat the company’s money as if it were my own,” he says. “Once you invest in IT, it’s a long-term commitment: human resources, equipment, licensing, security, and document retention. And as those costs accumulate, but flaws in management, training, or culture persist, you’ve just made a long-term financial commitment without actually fixing the underlying problems.”
As an IT executive in the healthcare industry, Dallal is unimpressed with the technology solutions that promise a golden record. Healthcare is inherently decentralized, so healthcare data will remain decentralized. “There is no such thing as the single source of truth,” Dallal says. “You wouldn’t bury all your treasure in one place, so why is the industry so anxious to do the same with its data?” Although the promise of a 360-degree view of a patient keeps the quest for the golden record compelling, compiling and storing all that information in a single database—rather than a number of smaller, distributed data caches—results in a single, high-profile target. If a breach occurs, all enterprise data becomes compromised at once. Instead, Dallal argues for a segmented model that keeps and protects data within its respective domains: clinical, financial, administrative, and more. A business intelligence solution can gather data from multiple sources and display it in a consolidated pane as if it were from a single source but without the ransom-ready model in the back end.
“Once you invest in IT, it’s a long-term commitment. And as those costs accumulate, but flaws in management, training, or culture persist, you’ve just made a long-term financial commitment without actually fixing the underlying problems.”
However, this approach works efficiently when you have control over your own data. “In our situation, all our transactional data was housed with our business associates, so we developed an internal data warehouse to achieve data autonomy and automate many of our business processes,” he says. “We delivered data marts and reports during the course of the project so the business could immediately benefit from the warehouse and not have to wait for data from our vendors.”
Dallal’s experience in the public sector—first as director at Cook County’s Bureau of Technology, then as CIO for the State of Illinois—quickly alerted him to technical and cultural differences between the public and private sectors. The technology he noticed tended to rely on older, proprietary systems that frequently lacked technical documentation and data integrity controls. Culturally, he recalls that the public sector was more bureaucratic, the salaries were less competitive, and the pool of interested, available talent was smaller. Dallal found it challenging to acquire and develop the talent he needed, and in 2015, he returned to the private sector.
Still, he recognizes that the environment helped him cultivate empathy and diplomatic skills. “It started with a certain empathy and understanding of another agency’s needs: their need for privacy, autonomy, and respect for the commitments they’ve already made to their stakeholders,” he says. Building trust was key, especially as a technical professional given access to sensitive data, and he learned to approach his colleagues with openness and a willingness to compromise.
Dallal admits that he’s optimistic about the ways in which the new administration in Washington could rebalance the structures of incentive and risk impacted by the Affordable Care Act. According to Dallal, a Milton Friedman enthusiast, the ACA—and the individual mandate in particular—distorted the way in which risk is distributed between patient, payer, and provider.
Some accountability for care, he maintains, will need to be shifted back to the patient. Under the mandate, Dallal says that payers and providers were required to carry the risk for an unknown, costly patient population, and many patients continued expensive behaviors such as using the emergency room as their primary care provider, even after being given fully subsidized health insurance.
With such broad uncertainties about the future of the payer-provider-patient relationship, thinkers like Dallal will discover opportunities to innovate. Imagine, he suggests, using an online portal to compare prices for a procedure, which, given specific parameters, displays available providers and the procedure’s postcoverage cost to patients. For now, though, billing and pricing are too cryptic for such a service to be useful. Providers don’t readily publish those numbers, perhaps, he says, because they are hesitant of a technology-driven, consumer-oriented disruption like Uber.
In his usual fashion, though, Dallal considers the technological innovation secondary. “Although there are technology solutions out there, those will not replace organizational discipline and a culture of innovative thinking. Creative solutions still have to come from people,” he says. “Healthcare technology may change how the game is played, but I want to change the game altogether.”
Editor’s Note: As of the time of publication, Land of Lincoln Health was no longer offering insurance policies to customers.