The HIT Deluge Part I: The Need and the Opportunity


There was a time–not too long ago, in fact– when it seemed safe and reasonable to define health information technology narrowly: the acronym encompassed the management of health information and its secure exchange between patients, providers, and insurers.

For many providers, the definition seemed to compartmentalize HIT. It was for someone else, perhaps the Ivory Tower crowd, but not for me. The nearly 90% of practicing physicians in the US that don’t use an EHR for example, might have sensed that someday they’d have to log on, but not any time soon.

And as for all that stuff about telemedicine and consumer driven health care, that made good topics for CME courses, but again, it wasn’t immediately relevant.

That began to change 15 years ago when nascent quality reporting initiatives began forcing physicians to deal with clinical performance data and the systems used to collect, analyze and display it.

It accelerated when patients began showing up in their offices with Internet-derived reprints of journal articles they hadn’t read themselves, and with pay for performance systems in which insurers tied a chunk of their income to the frequency with which they screened people for colon cancer and kept their diabetics’ HbA1c levels below 7.0.

But nothing in the past could have prepared physicians to deal with the overwhelming flood of HIT that inundates them on a daily basis today, a flood that threatens to sweep away long-established professional codes of conduct and disrupt the very processes by which care is rendered, doctors communicate with patients, and health systems interact.

The Obama administration’s push to disseminate EHRs via Medicare bonus payments for those who demonstrate “meaningful use” beginning in 2011, is but a tiny component of the Deluge.

Equally if not more important is the recent explosion of social media, a phenomenon whose unprecedented, indiscriminate growth has spared no sector of our society and taken health care by storm.

The newest generation of physicians has grown up with Facebook and Google, with Twitter and YouTube. They “get” the technology, but don’t always understand how its use affects their efforts to forge identities as medical professionals.

And for the rest of us, forget it. What in the world is all this stuff, and how dare we use it without getting burned by the fire?

Consider the following examples, which illustrate how the deluge affects physicians at every stage of their careers:

1) In his second week as a medical intern, Dr. Jain receives a “friend request” from an Erica Baxter on Facebook. Years ago, while he was a medical student, Jain helped deliver Baxter’s baby. Now she wants to reconnect. Is she simply a grateful patient interested in sharing news about her child, or does she have other motives? Jain clicks “confirm,” granting Ms. Baxter access to his network of friends, his personal photographs and blog, and the scrawls of others left on his wall.

2) Dr. Margolis, a middle-aged pulmonologist, receives about 120 emails per day. The assortment spans the range of her busy life. There’s an email from her oldest child who needs to be picked up at 6:30, not 5:30. Her dentist has an opening this afternoon and wants her to come in for a permanent fitting on her crown. Her secretary wants her to see a patient whose breathing difficulties have taken a turn for the worse.

And then there are emails from Dr. Margolis’ patients. Some are annoying, some can be handled by the nurse practitioner, and some reflect downright emergencies.

Problem is, Dr. Margolis is way too busy to read 120 emails per day. She’s lucky if she gets through half of them. She has a thousand unread emails in her inbox, many of which arrived weeks ago. She worries some may contain time-sensitive information regarding a patient.

3) Dr. Tapscott, in his late 60s and nearing the end of a satisfying career in family practice, is convinced by front-office personnel to begin using an electronic health record. “That $44,000 in bonus payments sure would help make ends meet,” he reasoned to himself at the time.

But the EHR implementation doesn’t go well. He has trouble getting the hang of the thing and believes the machine puts a barrier between himself and his patients. He expresses displeasure to his staff, one of whom leaves in a huff. Five months and tens of thousands of dollars later, he ditches the system.

Physicians have faced emerging ethical challenges before. Their struggle to develop professional identities is as old as the profession itself. And this isn’t the first time they’ve have had to incorporate new medical innovations into their daily lives, but the HIT deluge multiplies these challenges several fold, and creates myriad new ones, many of which remain vexing even to deep thinkers in the field.

Something has to be done to support physicians as they confront the HIT Deluge.

Thankfully, that’s possible and within our abilities to do so, at least for the most part. In subsequent posts of this series, we’ll explore the Deluge in detail and draw conclusions about what we need to do.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.

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12 replies »

  1. Housedoc – so much bull crap!
    The thing that keeps patients coming back to my practice is my caring attitude, the touch of my hand on theirs and the look of my eyes into theirs as I listen to what they are telling me, not what they are saying. A skill which is being lost rapidly with the advent of HIT.
    Your way is by making more money through less intimate contact and less time spent per patient.

  2. There is nothing wrong in taking advantage of advances in technology to expedite doctor patient communications. Right now there is a bottleneck resulting from the need for an office visit or a clumsy phone call. Think of how much more information would be exchanged if doctors and patients could be able to communicate online. That would only happen, however, if adjustments were made so that doctors were paid for their time. Right now that can be only done using online services such as that is HIPAA compliant and collects a credit card fee for the doctor at the time the patient requests the service. Its all up front and legal, and patients are greatful for the convenience. The only thing that keeps people back is us narrow clinging to the old way of doing things.

  3. “small individual practices will finally realize that in order to provider the best care to their patients they need to be large affiliated group practice teams since that is where the highest quality care is happening”
    Do you have any outcomes evidence to support this? Many of the European countries with much better health care profiles than ours are based on small primary care practices.

  4. Written by Pratice Fusion? Oh please.. The only docs who get that product are ones who want something for nothing so no wonder his view is skewed.. For those that don’t know here is their business model from Micki Tripathi
    “Practice Fusion, a San-Francisco-based startup is its hyper-commercial opposite. Launched last August, the company’s original plan was to offer their EHR without charge in return for access to the deidentified clinical data generated by users, which the company would sell to pharma companies, insurers, and researchers. If that isn’t controversial enough, the company announced last Friday that they’ll be partnering with Google’s advertising arm, AdSense, to put context-sensitive ads on the EHR in real-time.”
    A product like that will get consumers so mad that no one will be using an EHR (Cerner is now apparently is selling patient data as well – no need to get into the whole “deindetified data” there really isn’t any such thing unless you add noise to the data base vs stipping out data and make it useless to Phrama)

  5. If we are going to reform health care in the united states, we should start to think in terms of “Health Assurance” rather than Insurance. The insurance companies only support treatment of illnesses instead of providing prevention programs. Many illnesses can be prevented, however, going to the doctor to provide prevention advice is not covered by most health insurance policies. The bulk of research monies go to cures with very little towards preventative methods.

  6. All this fuss for bad HIT that does not provide redeeming improvement in the care or outcomes of patients.
    The best strategy for the docs is to sit tight. Don’t buy, don’t buy, don’t buy.

  7. I think the final EHR architecture will look nothing like what is under construction. By default, hundreds of vendors, and hundreds of standards, paired with a few hundred Rhios will never pass the triad test–meaningful use, certification, and interoperability, even if by some fluke the large systems (those above $10 MM) were even deemed to have been implemented successfully.
    I think in 6-8 years we will see a single, national, open, browser based EHR that looks a lot more link the ATM network or OnStar than what is being built today.

  8. An EMR by itself is nothing more then an electronic pencil and if you adopt health IT without simultaneously changing the workflows and the business models you will just drive into the wall faster.
    The goal should always be patient centered, high quality affordable care. In some regions like the PNW we have had EMR’s for the past couple of years, expect to be able to access our doctors by secure email (not mixed in with person email), have 24/7 access to real time care via consulting nurses, the ability to get our labs online, to have our records reviewed by specialists before we arrive etc and where our time is as valuable as providers.
    Perhaps the real outcome of health IT will be that small individual practices will finally realize that in order to provider the best care to their patients they need to be large affiliated group practice teams since that is where the highest quality care is happening or use technology to leverage that model into a virtual team. (aka a distributed virtual group practices)

  9. Success or failure of EHR implementation almost entirely depends on the purpose of that endeavor. If it is all about the ARRA incentive payments, failure is almost guaranteed. As with any other technology, potential users have to have a clear understanding what EHR is, what needs the system is to address, how it fits into the workflow, and what adjustments to internal processes are required to make care delivery better in all aspects.

  10. Healthcare IT will become a large industry and be vital to the world to cut costs and not hinder the transportation of records for patients anywhere easily.
    It may cost some initial investment and depersonalize the physician-patient relationship but may also make it more important as there is less paper work.
    A related blog I found is here
    Thinking about this topic makes me want to write an article regarding Healthcare IT on my blog

  11. Yeah, for the healthcare industry this is a huge inflection point, probably akin to moving from the agricultural age to the information age in a few short years (notice that the industrial age was skipped altogether).
    In addition to the enabling technologies that must be adopted, the HITECH Act’s Subtitle D regulatory regime transforms HIPAA from a paper tiger to a beast with electronic teeth.
    I believe that it will ultimately be an enormously productive ride, BUT there is going to be LOTS OF PAIN along the way. This is not your daddy’s healthcare industry anymore. We left Kansas a long time ago (i.e. in “Internet time”).