Fulfilling the promises of health information technology

In my last blog post, I wrote about the unfulfilled promises of health information technology based on recent studies and articles that have received a lot of attention. In this post, I want to pick up where I left off and provide some thoughts on where healthcare IT needs to go in order to fulfill at least some of these promises.

Today's prevailing breed of healthcare IT systems was designed years ago and with the fee-for-service model in mind. As the industry is shifting more and more towards value-based reimbursement models such as those underlying the emerging Accountable Care Organizations (ACOs), it becomes increasingly clear that incremental modifications to those systems are inadequate and leave healthcare providers struggling with productivity losses and financial uncertainties. As an example, most of today's EHR systems were designed as local silos of health information with antiquated or complex user interfaces and limited ability (let alone intent) to share information with other systems.

The reality today is that we live in a mobile and connected world. Patients are increasingly seeking care from many different physicians and nurses in many different places. In order to prevent illnesses from developing in the first place, or to provide optimal care and reduce cost if they do develop, these physicians and nurses have a need for better tools to communicate, coordinate and collaborate -- not just with each other but with their patients as well. In recent years, the Internet, consumer electronics and mobile apps have shown us how to accomplish this. I am better connected with friends all over the world through social networking apps than to my primary care physician a few miles down the road. Wikipedia allows for better, more instantaneous collaboration and sharing of information across the globe than the tools physicians are generally using to document healthcare encounters today. We need to change that.

What we need are applications for care providers to securely join a virtual care team for a particular patient from any location using a variety of devices:

  • Depending on their role, they get presented with the patient information that's important to them with respect to the specific clinical care they provide.
  • They can see how the patient is doing relative to the care plan they jointly manage against.
  • They can see how potential treatments have worked on populations of similar patients with similar disease patterns and see personalized best-practice guidelines based on the latest research results combined with big data analytics.
  • They can easily communicate with other care team members or with the patient, and they can efficiently document and share new information about the care they provide without getting bogged down by administrative, billing or malpractice requirements (those are being handled by service providers accessing the same system remotely -- closely collaborating with the care team).
  • Rather than pointing and clicking through complex, template-driven user-interfaces, they conveniently and efficiently narrate their findings in their own words, telling a patient story that is meaningful to the next care provider, yet also accessible to computers through natural language understanding technology.
  • Patients measure their vital signs and can perform basic lab tests at home, using a variety of off-the-shelf add-ons for their mobile devices. This data immediately becomes available to the entire care team and abnormal values automatically initiate corrective action. Patients also manage their health more effectively by monitoring key health indicators and receiving suggestions from their care providers through their device of choice -- smart phone, tablet or PC.

Sounds futuristic? Not really. These are not revolutionary new ideas -- much of this has been realized in other industries and some of this is emerging already in the form of innovative healthcare applications, particularly in the area of home health monitoring. Healthcare has always been more resistant to change than other industries. Change will come though, accelerated by new regulatory and reimbursement models, and decision makers in hospitals and physician practices are well served looking beyond the capabilities of their current healthcare IT infrastructure.

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