I thought I’d share my thoughts on this December 2010 report to the US President entitled “Realizing the full potential of Health Information Technology to improve Healthcare for Americans: The Path Forward“.
It’s a 50+ page document compiled by the President’s Council of Advisors on Science and Technology (PCAST) which is an advisory group administered by the White House Office of Science and Technology Policy (OSTP) and made up of the “nation’s leading scientists and engineers, appointed by the President to augment the science and technology advice available to him from inside the White House and from cabinet departments and other Federal agencies”.
Incredibly I found only a single mention of mobiles/cellphones and this was in relation to a rather odd reference suggesting there was a mass market adoption of “PHRs” that are being offered as “software packages that allow consumers to store and maintain data on personal computers, mobile phones, or other digital devices”. Worse still there was no mention of wireless networks despite the report correctly articulating that:
> “Health information technology could improve the quality of healthcare and reduce its cost”
> PHRs “‘travel with’ the patient”.
> “healthcare should be organized around the needs and specific characteristics of the patient, not around those of the hospital, doctor’s office, insurance company, or EHR vendor”
> “Medicine has become an informationrich enterprise, and a larger and more seamless flow of information will result in a transformation of care, organized around the patient, wherever he or she may be”. I wonder if the authors ever asked themselves what other digital devices are with patients wherever they may be?
> Improved access to patient data is an “important benefit… …which can help clinicians as they diagnose and treat patients and patients themselves as they strive to take more control over their health”
> HIT can “streamline” the “monitoring of public health patterns and trends” and “clinical trials of new diagnostic methods and treatments”
So are they getting it wrong? How can they be missing the mark so widely? Here are my thoughts:
> The President’s Council of Advisors on Science and Technology contains no one working for a wireless carrier (Mobile Network Operator) and nor did the 47 “expert inputs” include any. A big oversight when telco providers dominate HIT spending especially as we’re enter an age when medical devices are increasingly being connected and the value of these devices are being increased so much through connectivity. It might be an omen that the author who works closest to the newest Trillion Dollar industry is Google’s “Mobile Mobile Mobile” CEO Eric Schmidt and probably the biggest threat to the wireless carriers business model!
> Zero mention of the smartphone device makers eg. Nokia, Samsung, BlackBerry and Apple – are the authors living in a cave!?!? Have they not seen how the world of Healthcare providers (from Social Workers & Organ Transplant Teams in the UK to Surgeons in Tanzania) around the world are leveraging these devices to increase the speed, quality and efficiency with which they are providing care?
> In the “New and emerging technologies” section of the report they describe “cloudbased EHR products that are suitable for small providers”, “personal health records aimed at patients” and “middleware products designed to make legacy systems interoperable”. Is this really “new” or “emerging” in 2011? Are they intentionally ignoring the rapid adoption of hundreds of thousands of smartphones by clinicians – who are typically buying this powerful HIT technology for themselves?
> How have they managed to not even mention the enormous public health opportunities offered by mobile phones (surely Ed Penhoet, Professor of Public Health at the University of California, Berkeley, knows all about these?)
> “Presentday EHRs often require a substantial increase in physician time devoted to documentation… …streamlined data entry via checklists, customizable templates, and other structured means is an area of opportunity for software and systems designers”. Why don’t they consult the countries foremost academic talents who have already tested and produced evidence for solutions that simultaneously empower patients.
> “Technology-Enabled Diagnoses: Imagine a patient with the history of hepatitis C who presents to a primary care physician complaining of an itchy rash. When the physician dictates or types the words “new rash” into the record, the record instantly reminds the physician that hepatitis C has associations with certain diseases, including a condition known as lichen planus that triggers an itchy rash. The decision support system can remember all of the associations between patient clues and medical diagnoses. It then becomes the job of the clinician to navigate the evidence and assess the situation with the richer information that is instantly available” Once again before spouting some wildly optimistic conclusion that the practice of medicine is going to simply converge with the black art of painting by numbers, why don’t they consult the countries foremost academic talents who have tested and proven solutions for this?.
In summary: If this is the quality of information the Presidents office is reliant on my money would be on the private sector reforming the US HIT industry by taking an approach that is focused on the Doctor/Patient experience.