Saturday, April 27, 2013

Disruptive Innovation in Health IT: A Path to Acceptance (Part 8)

In this eighth post of the series on disruptive health IT (see this linkto start from beginning), I examine a key element that EHRs systems need, and a EHR good companion application should provide Patient-Centered Support (PCCS).

Here's a brief explanation of PCCS and what a PCCS-enabled EHR system would do:

  • Clinicians have a “virtual patient” in mind—a conceptual model of an actual patient that reflects their understanding of the patient’s problems and needs
  • This virtual patient model (VPM) consists of multiple submodels reflecting the interaction between biomedical and psychological subsystems in the real patient
  • New findings—raw data—are used to refine the VPM
  • PCCS-enabled software provides clinical decision support by:
    • Simulating and predicting the likely reaction of the VPM to different care interventions
    • Identifying the interventions most likely to benefit the actual patient
  • Without PCCS-enabled software to help make decisions, clinicians may:
    • Spend considerable time and energy searching and sifting through all the raw data
    • Have to integrate ill-structured, uncertain, and potentially conflicting information
    • Experience information overload, confusion, uncertainly and doubt
  • With PCCS-enabled software, a clinician:
    • Has much less cognitive burden
    • Makes decisions supported by deeper &; clearer understanding of the patient
    • Can stay focused on implementing the patient’s care plan
  • Patients should also have a version of PCCS software available.
The whole product companion applications I've described in previous posts in this thread will focus, in part, on developing, evolving, and deploying EHR companion applications that are PCCS-enabled. Toward this end, we are prepared to offer:
  • A novel, robust software development platform that uses off-the-shelf software tools to create and continually evolve next-generation analytical decision models
  • A communication architecture that promotes collaboration in loosely coupled social networks
  • The means to combine the development platform and communication architecture to provide:
    • “Technological glue” that connects companion app components via the CP Split method
    • “Model ecology networks” in which teams of collaborators build, share, evaluate, and evolve analytical decision models, which they may sell.
Implementing this strategy will be done through collaboration among a widespread alliance of business partners. We are compiling lists of people and companies we believe may be interested in receiving an invitation to join the alliance. They include clinicians of all types, informaticists, analytical decision model-builders, and EHR vendors.

I'll have more to say about the alliance in subsequent posts.

Thursday, April 11, 2013

Disruptive Innovation in Health IT: A Path to Acceptance (Part 7)

In this seventh post of the series on disruptive technology (see this link) to start from beginning), I describe the technical capabilities of whole product “companion applications” that can bridge the gaps in today’s EHRs and PHRs, thereby enabling them to fulfill their potential for increasing healthcare value.

There are at least five areas of EHR and PHR functionality that whole product companion applications can substantially improve:

1. Data Capture, Storage and Integration
Able to manage and integrate an unlimited variety (types) and quantity of data for every patient—over his/her entire lifetime—using existing and/or new standards

  • Images (e.g., x-ray, MRI, CT, ultrasound) 
  • Structured data from EHRs, PHRs and other sources 
  • Semi-structured data 
2. Analytics, Big Data, and Clinical Decision Support
3. Presentation/Advanced data visualizations
4. Transport
Information exchange with global interoperability using:
5. Usefulness and Usability
  • Easy and inexpensive to use and maintain 
  • Streamlines workflows 
  • Provides simple and intuitive user interface 
  • Delivers useful information targeted to different user roles and types of users 
  • Accommodates user functional limitations, intellectual and knowledge capabilities, etc.
In my next post, I discuss how we are using our disruptive innovation to enable development of whole product companion applications. I then present our plans to form an alliance of partners to create and market those products with a sincere focus on dramatically increasing healthcare value and rewarding those who contribute to such a worthy goal.

Monday, April 01, 2013

Disruptive Innovation in Health IT: A Path to Acceptance (Part 6)

In this sixth post of the series on disruptive technology (see this link to start from beginning), I will present an overview of the capabilities and deficiencies of today's EHRs. In my next post, I will show how a novel whole product solution, consisting of EHR Companion Applications, can bridge the gaps that prevent today's EHRs helping to increase healthcare value.

Current EHR Capabilities

Efforts up to this point have focused mainly on the most basic functional level of health IT, i.e., the development of EHRs for inputting, validating, storing and presenting basic patient data. Current EHRs also offer some decision-support through reminders and alerts (e.g., follow-up appointments, inoculations, and medication prescription checks), and may streamline certain workflows. While a necessary first step, much more is needed before EHRs can demonstrate the ability to foster significant improvements in healthcare quality, cost and safety.

Current EHR Deficiencies

EHR systems hold great promise in helping increase care value. Nevertheless, they have serious deficiencies that have not only weakened EHRs’ ability to help improve care, but have also led to widespread dissatisfaction among users. Despite the fact that “doctors are often prohibited from voicing specific concerns about a…system publicly” [reference], there are still many reports about their weaknesses, some of which are discussed below:
  •  Difficult to use and not interoperable. “The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems” [reference]. “Providers continue to use workarounds to deal with perceived inadequacies of their electronic health records…such as difficulty in finding data and complex order entry processes” [reference].
  • Fail to coordinate care and accommodate workflows. “Knowing all the different participants in the patient’s care team…and coordinating and integrating their electronic activities is what successful EHRs must handle with ease…Most existing EHRs…have…done a poor job [and] must...accommodate more fluid workflows that can change potentially daily or weekly based on the demands of new participants” [reference].
  • Cause information overload. “EHRs often contain unnecessary or excessive information that "clutters the 'big picture' of patient care" and increases risk to patients…often you can't see the forest for the trees” [reference].
  • Immature clinical decision support. “[T]he first generation of CDS [Clinical Decision Support] tools…in…EHR systems, has not lived up to expectations…[They cause] alert fatigue and [fail to] optimize [clinical]workflows” [reference]. “[F]uture generations of CDS tools will…be more tailored to both patients and physicians” [reference]. “[Additional R&D] is recommended…to bridge the gap between the promise and realization of [guided personalized medicine]” [reference].
  • Does poor job with patient education and shared decision-making. “…health education materials delivered by EHRs are ‘rarely…understandable and actionable for patients’ who have low health literacy” [reference]. “Implementing shared decision-making isn't as easy as it sounds…the IT systems used…lacked capabilities to flag patients as candidates for decision aids or to track patients through the process” [reference].
In my next post, I describe the technical capabilities of whole product companion applications that are able to bridge the gaps in today’s EHRs and PHRs.