Sunday, January 18, 2009

National Research Council Report: How to Fix What’s Wrong with Today’s HIT

As recently discussed on The Health Care Blog, the National Research Council of the National Academies released a draft report titled "Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions," which criticized the bulk of today's health information technologies (HIT) and offered their advice. The following quote summarizes the Council's primary conclusion:

In short, the nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade. In the quality domain, various improvement efforts have failed to improve health care outcomes, and sometimes even done more harm than good. Similarly, based on an examination of the multiple sources of evidence described above and viewing them through the lens of the committee's judgment, the committee believes that the nation faces the same risk with health care IT—that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even set back the cause if these efforts continue wholly without change from their present course. Success in this regard will require greater emphasis on the goal of improving health care by providing cognitive support for health care providers and even for patients and family caregivers on the part of computer science and health/biomedical informatics researchers. Vendors, health care organizations, and government, too, will also have to pay greater attention to cognitive support. This point is the central conclusion articulated in this report.

The path the recommend includes a call for radical change; I quote:

Change in the health care system can be viewed through two equally important lenses—those of evolutionary and of radical change. Evolutionary change means continuous, iterative improvement of existing processes sustained over long periods of time. Radical change means qualitatively new ways of conceptualizing and solving health and health care problems and revolutionary ways of addressing those problems. Any approach to health care IT should enable and anticipate both types of change since they work together over time.

Their conclusion and recommendations are consistent with something I posted previously about predictions the HIT would control healthcare costs and improve care quality, whereas results for the current crop of products show there is much room for improvement. Adoption rates are very low and those using HIT have seen poor to mediocre return on investments.

I fully agree with report's point that a key part of the solution requires radical HIT innovation. I'm not talking creating about variations of conventional products that now crowd the market. Instead of these relying on such unimpressive "me-too" commodities, I'm we ought to be developing and promoting dramatically different types of software applications—a new generation of truly useful tools ("disruptive technologies/innovations")—that enable healthcare consumers and care providers to seamlessly manage health risks and problems through innovative integration of knowledge and technology that enriches healthcare systems.

To be of value, these disruptive innovations should include radical alternatives to the extremely complex interoperability and technology standards, the inefficiencies of XML, and the costly centralized systems that dominate the HIT landscape. In addition, we need radical alternatives to the inflexible software programs that do little to support providers' clinical decisions, to aid consumers/patients in their self-care, to coordinate care across healthcare disciplines, and to enable researchers to generate and disseminate evidence-based guidelines.

These next-generation HIT architectures and programs should be extremely flexible, modular, ever-evolving, easy-to-use, low-cost, and secure. They ought to:

  • Help consumers make wise health decisions and understand the impact of their choices on their physical health and psychological wellbeing (see this link)
  • Help consumers deal with chronic conditions by supporting health education programs promoting effective self-maintenance (see this link)
  • Allow consumers to authorize health data sharing at a granular level of control for optimal privacy (see this link)
  • Maximize healthcare value and safety by promoting ever-more efficient and effective care through development and deployment of evolving evidence-based guidelines for treating illness and fostering wellness/prevention (see this link)
  • Support whole-person (mind & body) care within a patient-centric life-cycle value chain (see this link)
  • Promote both the continuity of care and the integration of sick-care and well-care (see this link)
  • Protecting populations with better biosurveillance and post-market drug & medical device surveillance (see this link), as well as supporting first-responder and trauma center staff (see this link).

In the next few weeks I will demonstrate a disruptive innovation I began developing in the early '80s, which shows a unique way to satisfy these daunting requirements.

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