Health IT: Putting Better Healthcare before Widgets

December 18, 2012
Marion K. Jenkins, PhD, FHIMSS

While the current focus on health IT tends to be on features or capabilities, it's time to take a look at the higher purposes of these devices and software.

In working in healthcare technology for over a decade, we have been involved in hundreds of discussions, demos, and presentations by vendors, consultants, and industry experts on various aspects of healthcare IT, and we have seen firsthand the unprecedented advancement of both hardware and software components. The pace of that advancement continues to accelerate.

However, most vendors and consultants tend to focus on a small piece of the pie …a specific EHR system, or a specific type of user device such as a tablet PC or a COW (computer on wheels), or a sub-system such as e-prescribing, CPOE, or device interfaces. Many demos focus on the "widgets" - the software and hardware components that can easily fit into a brief Web or on-site demo, or be portrayed in a brochure. Therefore, the focus tends to be on a specific (and typically small) subset of features or device capabilities.

This presents many challenges to physicians and other healthcare stakeholders. The first one is fairly obvious: It is very difficult for healthcare practitioners to understand and sort through all the IT techno-babble. Second, users frequently can become confused about where the capabilities of one system or component end and where another one starts. When participating in a demo, a user may assume that System X might do everything a practice or a clinic could possibly want, whether it’s billing, data aggregation, imaging, scheduling, etc. Unfortunately once a system is installed, the user may discover that the system does not do everything they thought it would do - or they were led to believe it would do.

Unfortunately, ARRA/HITECH and meaningful use, which were intended to promote the adoption of healthcare IT systems in general and EHRs in particular, has contributed to this isolated, piece-part view of healthcare IT components and systems. ARRA/HITECH tends to focus solely on the EHR. While today’s full-featured EHR (which typically also includes a practice management system) is able to handle most of the business and clinical needs of a medical practice, there are still many business and even some clinical processes that may be outside of – or not be properly handled by – even a fully integrated EHR system. This may include the practice’s financial reporting system, letters and correspondence for the business, board meeting minutes and notes, human resources, and other critical business functions.

On the hardware and device side of things, tablet PCs, smartphones, and other user devices have exploded in popularity, often times without regard to usability, survivability and HIPAA Security Rules. Indeed, the theft and/or loss of portable devices has become the leading cause of HIPAA data breaches. This situation has been significantly exacerbated by the BYOD (Bring Your Own Device) movement within healthcare facilities. It is no longer feasible for the IT department to specify and “lock down” each and every user device. This is a classic case of the adoption of one component to improve some processes and systems negatively impacting others.

Regardless of whether the discussion concerns hardware or software, healthcare technology needs to be designed and implemented from a system point of view. And the crowd-pleasing features of a particular device or software package mask the higher purpose of healthcare technology, which should be to support the triple aim developed by the Institute for Healthcare Improvement:

1. Improve the patient experience of care (including quality and satisfaction)
2. Improve the health of populations
3. Reduce the per capita cost of healthcare

The ultimate goal is not just speed, it is improved healthcare work flow, whether one is discussing the use of patient portals to streamline the patient check-in process, or the use of clinical decision support systems to improve the efficiency accuracy of a provider-patient encounter.

Only when healthcare IT vendors, suppliers, and consultants view their solutions as part of an entire system, and work with the healthcare stakeholders to develop and implement healthcare IT systems which positively contribute to improved healthcare workflow, and recognize that the purpose of healthcare IT is to make healthcare better for all players, will the true value be realized.

Next blog: Today’s healthcare data - electronic silos are only marginally better than paper silos.