Fact: Before the web
about 20 years ago, roughly 4,000 people from 200 companies congregated in San
Diego for a conference to talk about the future of health-care information
technology. This was long before the
technology of the WEB begins, when computers in physicians’ offices were used
only for scheduling and billing patients and paper charts bulged out of huge
filing cabinets.
It was one of HIMSS’s or Information and Management Systems
Society’s first big conferences. Several
physicians, technologists, visionaries, engineers and entrepreneurs shared one
idealistic goal, a goal to use information systems and technology to
fundamentally change health care. The intention was not just to improve the old system but a
future that looked a lot like we were being promised throughout the economy as
it sped into the Internet era. The aim
is for the computers enabling improvements in the practice of medicine to make
it safer, higher quality, more affordable and more efficient, all in for one
same goal, to make the people healthier. A company that was called Allscripts was then built not long
after the said conference. Its focus was
electronic prescriptions. The old joke
about impossible to read doctor’s handwriting was after all no joke, because
according to The Institute of Medicine, about 7,000 Americans were dying each
year from paper prescription errors. The first fully electronic prescription using Allscripts
system was transmitted by an innovative physician named Azar Korbey of New
Hampshire. As of today about 600 million
prescriptions out of 1.5 billion in the U.S. are written electronically, this
is according to industry source SureScripts.
This is a considerable development but there is more to do but it is
safe to say electronic prescribing is saving lives.
Rivals have a common goal, Allscripts, Cerner and Epic, to
make all physician practices and hospitals digital. So the next phase was electronic health
records. These competitors found ways to
automate a complicated clinical encounter. The goal seems didn’t seem to be unattainable although
putting PCs on every desk was only the first step in the information
revolution. And it all started when
these PCs were then connected to the Internet and developed “apps”, everything
changed. Consider Amara’s Law: “We tend
to overestimate the effect of a technology in the short run and underestimate
the effect in the long run.”
The whole process has been hard, from zero to getting nearly
half a million physicians using electronic records, required a tough
effort. Rewording Churchill, this is not
the end. It is not even the beginning of the end. But is it, perhaps, the end
of the beginning of the electronic health revolution. There had been many critics and disbelievers trying to knock
the value of the investments in the system, pass judgment on the government’s
stimulus, and doubted the return on investment.
An open letter to president Obama by David Kibbe, a physician and
technology advisor to the American Academy of Family Physicians, says that
electronic health records are “notoriously expensive” and “difficult to
implement.” Disagreeing about subsidies,
Kibbe wrote: “Nor is there conclusive evidence that the use of EHRs improves
patient care quality.” More people now understand that making digital records work
is critical to fixing health care. The
annual HIMSS conference held last week in New Orleans is expecting 35,000
people and 1,000 vendors to focus on that task.
“The impact of IT on health care over the past decade has so
far been modest,” this is concluded by the President’s Council of Advisors on
Science and Technology concluded in a recent report. The key words: so far. Investors and the
industry would be wise not to underestimate what’s coming. It is nothing short
of an explosion in innovation and creativity, facilitated by open systems and
connectivity. The technology can fix itself; this is was what the council
has found out. “The ability to integrate electronic health information about a
patient and exchange it among clinical providers remains the exception rather
than the rule,” this is what the report saying right now and this is exactly
what need the change. The job on getting all the physicians on board is still on
going, while the CDC reported in December that 73% of physicians now use
electronic health records, up from about a third two years ago. This means a great progress yet there are
still many physicians using paper. Next step is to get all the records connected to each other,
this means the industry, through HIMSS and the government, through the Office
of the National Coordinator, are pushing for interoperability. For the time being, the existing systems that were already
installed needs improvement. This is
because they are not user-friendly, and this claim is from someone who spent 15
years developing and selling them. With
the development of the new iPad and other mobile apps, this will help the
industry to do better and it will.
Electronic health records today tend to be “information retrieval” tools
and we have to vitally change it.
Human health will be improved once records are open,
connected, and more user-friendly, we can start to add intelligence to the
network that will help doctors, nurses, care coordinators and patients all do a
better job. Health care in next to no time will be overflowing with
similarly exciting start-ups producing apps that alter everything. We actually see it is starting to happen;
ground-breaking companies like dbMotion are linking dissimilar systems across
health care organizations. Other
innovators, like Humedica recently acquired by OptumHealth, they are learning
how to mine data for insights that will help physicians and care coordinators
keep track of large panels of patients. Medical apps that dial into electronic health records at
last are starting to be seen everywhere. This will impact cost and quality in
very significant ways like an example is a wireless scale can notify a nurse
when a congestive heart failure patient gains weight indicating dangerous fluid
retention. Or just look how convenient
this will be, wearing a device that allows your vital signs to be remotely
monitored all the time, rather than at a once-a-year doctor visit. “Technology, properly applied, is indistinguishable from
magic.” It is the “applied” part of that dream we are still working on. But I’m
confident we’ll get there. A connected system will help patients take
responsibility for their health. Strong teams of physicians, nurses and
caregivers will use an intelligent network to make their results better and
their jobs easier. It does sound like magic. And we are getting closer each
year. Just take a walk around HIMSS and you’ll see the future.—Arthur C. Clarke
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