In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.
Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.
Why? I’ll give you one good reason and one bad one.
A countless number of companies and technologies and ideas were harmed — and, in fact, blown up completely — between the days of the brick Motorola cellphone and the iPhone of today. Remember “DSL” companies that connected houses to the internet over copper wire? Remember “booster antennae”? Remember when we all thought the “flip phone” was the shizzle?
There are many corpses scattered in the wake of the Internet and cellphone renaissance that has occurred over the past 20 years and we are all fine with that. The young engineers and designers that were part of exploding companies simply took their backpacks and mini-fridges and went to the next cool company. When the company worked out, the options for these young engineers and designers were worth millions. When it didn’t work out, they moved on.
But there’s a big difference when it comes to health care. If each of these companies had been dealing in critical patient information in an EMR and lives were at stake, this would have been a dangerous game. The innovation would have been faster but the collateral damage would probably have been too much for our social values.
OK, now here is the bad reason:
The market for exchanging information in health care, specifically for sending referrals, is, in many cases, not legal. I’m not kidding. A few years after we nationalized health care coverage for seniors (Medicare) and for those in need (Medicaid) in 1965, we also made it illegal for the sender of a patient to be given anything of value by the receiver of that patient.
There was a good reason for it as we were afraid of kickbacks driving up federally funded care. Well, federally funded care has gone up quite a lot since it was originally funded, but no supply chain emerged.
Cellphone carriers can pay retailers who hook up folks to their network, but specialists can’t pay primary care doctors for the effort required to send clean electronic clinical info over to them that would improve care and reduce duplication.
If they could, there would be a lot more than, like, six Wired readers using their engineering talents in health care. (Hi! Please come work at athenahealth.) Instead, the only information systems that people pay for are those that work within their own controlled environments. There are legacy, non-cloud software systems that are only useful for exchanging information within the institution that owns that particular IT system. Weird, right?
As a result, in the last three years, we have hospitals that bought an EMR under the HITECH Act (and Meaningful Use) that have also bought the practices of the doctors that use them! We have gone from some 22 percent of docs employed by hospitals in 2008 to about 44 percent employed by them today. Making people work for you in order to exchange information with them is not exactly New Age. And most of those doctor acquisitions will fall apart in the next three years. You heard it here first.
The good news is that, even despite these obstacles, the obvious benefits of cloud computing, especially through electronic medical records, are driving health care into the 21st century. We at athenahealth are growing like crazy and we serve all our clients on one single instance of our web-native application. We are also being asked by our clients to move information in and out of legacy systems that don’t communicate well. We have even gotten the federal government — the Office of the Inspector General in the Department of Health and Human Services, to be exact — to bless a small ($1) interchange fee as “NOT a kickback” in order to attract more entrepreneurial energy into the efficient exchange of clean health information.
All of this makes me feel like heady times are ahead in health care. Even though we are watched by a nervous, panicky government that doesn’t quite get the deets, enough good seems to be getting done for Uncle Sam to continue letting us move about the cabin. And the government is getting behind the cloud — or, at the very least, not getting in the way of it.
So, people of Wired, come to health care! The water is, well, a little chilly, but it’s getting warmer all the time. In fact, I’d say spring really is here!
Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School. This post originally appeared in Wired magazine’s Cloudline blog.