A (Not So Silly) Vision For U.S. Health IT

Today, I logged into Twitter and what did I behold but this sweet little tweet by a health it strategist:

@ReasObBob: If headline was, “US has most useful, useable and interoperable #EHR and #HealthIT systems”, what would you think?”

My first thought was “cue the sitcom laugh track” and my responding RT included a hearty”LOL!!” Another retweeter said they’d think they were reading a parody by the famously snarky humor mag The Onion.

But hold on, here. Maybe Bob’s question can yield some useful responses that go beyond cynicism and humor. I’d like to lay out a few features of the health system the question envisions. This will be just a beginning — I’m sure many of you could outdo me by several orders of magnitude — but let’s get started.

Here’s just a few details of future history of the U.S. health IT system, as I’d prefer it to be. Tag, it’s your turn!


* Useful:

– Health IT in the U.S. is accessible to every stakeholder (patient, clinician, researcher, others as needed)
– Health IT devices make it simpler, or easy, for every stakeholder to create a feedback loop in which add information, get relevant feedback and respond to that feedback
– Health IT is used to make healthcare collaborative
– Health IT tracks health status efficiently and plays a direct role in improving outcomes

* Useable:

–  Health IT takes advantage of  the best of consumer technology design (as it has already begun to do in the mobile sphere), for both  personal useability and tools for aggregating data
— The health IT tools professionals use do more to encourage development of products and services that bear t he end user in mind (i.e. the end user isn’t a second thought or an obstacle to work around)

* Interoperable:

– Health IT vendors work together across a highly compatible standard (similar to say, 802.11n in the wireless world) which puts the issue of walled gardens to bed permanently
–  Health IT vendors are rated on interoperability with the unified standard that governs the U.S. EMR world
– U.S. health IT is interoperable with EMRs in other countries

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

1 Comment

  • Anne –

    As I mentioned in a follow up Tweet, as a consultant I often use a technique called “Envisioning the Ideal.” The focus is on defining the attributes of the — in this case – ideal EHR or other health IT system.

    The approach used to gather design and functionality specifications for EHRs and health IT systems can best be described as a cottage industry with each vendor (cottage owner) using different ways to codify the specifications they have somehow received from some group of people that may or may not include clinicians. Then, to each individual vendor’s closely guarded specification set, federal regulators mandate that certain functionality be included in those EHR systems if the vendor would like their product to qualify for meaningful use incentive payments. (Presto! Hundreds of new and different EHRs are suddenly available.)

    The result is two very different approaches to specifying the functionality of HER and health IT systems. Anyone can see how well that’s working.

    If that’s the current system, what would an ideal approach to specifying and designing EHRs and health IT systems look like? Here are a few attributes of what I consider to be ideal

    • The approach to gather functional and design specifications is treated for what it is — a large but very doable project with defined roles and timeframes.

    • The project would be staffed by professionals who know how to quantify design attributes and functional specifications allthe way from the user interface to the construct and content of the messages to be exchanged with other clinicians or organizations.

    • The techniques used to collect and refine the functional and design specifications – gathered from the users of the systems being designed — are based on leading practices in use by information technology systems development professionals that include, mediation, curation and publication.

    • The effort to gather the functional specifications is managed – either directly or indirectly – by the healthcare community through its associations and professional organizations and not left to the HIT vendors or regulators as inthe current approach.

    • It is clearly understood that while it will be possible –- and desirable — to define all required functionality needed within the health care provisioning ecosystem, not every site need all system capabilities.

    • Site specific applications such as pediatrics, orthopedics, level-III trauma center, etc. — that can exchange standard defined message sets — will emerge.

    • The systems designers will recognize the health care provisioning ecosystem is a classic example of a dynamic adaptive network with nodes that communicate with each other. The underlying technical architecture of all EHRs and health IT systems should mimic and accommodate that model if inter-nodal communication is considered important. It still is, isn’t it?

    Those are just some of the attributes of an ideal approach that has emerged from the research that Steven Waldren and I are now completing.

    If we really want to have the best, most useful, most useable and most interoperable EHRs and health IT systems we have to do something different.

    We think it’s about time to do it right.

    – Bob Brown

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