Friday, March 15, 2013

The RAND Corporation Offers A View Of the Future Of Health IT. We Need To Work At It.

This appeared a little while ago.

The Delayed Promise of Health-Care IT

February 26, 2013
Because information technology (IT) has so quickly transformed people's daily lives, we tend to forget how much things have changed from the not-so-distant past. Today, millions of people around the world regularly shop online; download entire movies, books, and other media onto wireless devices; bank at ATMs wherever they choose; and self-book entire trips and check themselves in at airports electronically.
But there is one sector of our lives where adoption of information technology has lagged conspicuously: health care.
Some parts of the world are doing better than others in this respect. Researchers from the Commonwealth Fund recently reported that some high-income countries, including the United Kingdom, Australia, and New Zealand, have made great strides in encouraging the use of electronic medical records (EMR) among primary-care physicians. Indeed, in those countries, the practice is now nearly universal. Yet some other high-income countries, such as the United States and Canada, are not keeping up. EMR usage in America, the home of Apple and Google, stands at only 69%.
The situation in the US is particularly glaring, given that health care accounts for a bigger share of GDP than manufacturing, retail, finance, or insurance. Moreover, most health IT systems in use in America today are designed primarily to facilitate efficient billing, rather than efficient care, putting the business interests of hospitals and clinics ahead of the needs of doctors and patients. That is why many Americans can easily go online and check the health of their bank account, but cannot check the results of their most recent lab work.
Another difference between IT in US health care and in other industries is the former's lack of interoperability. In other words, a hospital's IT system often cannot “talk” to others. Even hospitals that are part of the same system sometimes struggle to share patient information.
As a result, today's health IT systems act more like a “frequent flyer card” designed to enforce customer loyalty to a particular hospital, rather than an “ATM card” that enables you and your doctor to access your health information whenever and wherever needed. Ordinarily, lack of interoperability is an irritating inconvenience. In a medical emergency, it can impose life-threatening delays in care.
A third way that health IT in America differs from consumer IT is usability. The design of most consumer Web sites is so obvious that one needs no instructions to use them. Within minutes, a seven year old can teach herself to play a complex game on an iPad.
But a newly hired neurosurgeon with 27 years of education may have to read a thick user manual, attend tedious classes, and accept periodic tutoring from a “change champion” to master the various steps required to use his hospital's IT system. Not surprisingly, despite its theoretical benefits, health IT has few fans among health-care providers. In fact, many complain that it slows them down.
Lots more here:
Especially as we consider what the next Health IT Strategy should look like we need to consider both the scale of the problem and the urgent need to address it for all our sakes.
A good summary of the problem.


InformaticsMD said...

re: Not surprisingly, despite its theoretical benefits, health IT has few fans among health-care providers

you need to qualify:

"Bad health IT has few fans among health-care providers."

Imagine an unregulated drug industry where, worse, all drugs any manufacturer can produce are deemed "good drugs" because, well, they replace herbs and witchcraft.

linicians are criticized for complaining about drug side effects or deaths, and clinicians and patients are kept in the dark about the risks.

That's the situation in health IT.

It must be recognized that terms like "EHR" and "EMR" are obsolete.

From the recent U. Cambridge/Microsoft article "From the article "Private traits and attributes are predictable from digital records of human behavior":

A growing proportion of human activities, such as social
interactions, entertainment, shopping, and gathering in-
formation, are now mediated by digital services and devices. Such
digitally mediated behaviors can easily be recorded and analyzed,
fueling the emergence of computational social science (1) and new
services such as personalized search engines, recommender systems
(2), and targeted online marketing (3)."

It should be recognized that, in computerized hospitals for example, Health IT devices mediate most if not all activities of provision of healthcare.

Devices of such import - with the inherent risk entailed - need to be treated as such.

Trevor3130 said...

Ross Anderson (UK guru) is still working at it. See his slides.
Judith Sloan offers her insight into the endless machinations of DoHA.
AGIMO may be working at another level.
Of interest more broadly to agencies, big data analysis may provide profound insights into a number of key areas of society including health care, medical and other sciences, transport and infrastructure, education, communication, meteorology and social sciences.