Yesterday we tried to put EHRs into perspective. They’re important, and
we can’t effectively move health care forward without them. But they’re
only one of many important health IT functions. EHRs and health IT
alone won’t fix health care. So developing a comprehensive but
effective national health IT plan is a huge undertaking that requires
broad, non-ideological thinking.
As we’ve learned so painfully elsewhere in the economy, the danger we
face now in developing health care solutions is throwing good money
after bad. We don’t merely need a readjustment of how health IT dollars
are spent. We need to reboot the entire conversation about how health
IT relates to health, health care, and health care reform. To get
there, we need to take a deep breath and start from well-established
and agreed-upon principles.
Most of us want a health system that, whenever possible, bases care on
knowledge of what does and doesn’t work – i.e., evidence. We want care
that is coordinated, not fragmented, across the continuum of settings,
visits and events. And we want care that is personal, affordable and
Most of us also agree that, so far, we have not achieved these ideals.
In fact, health care continues to become costlier, quality is spotty,
and the gap between the health care we believe possible and the current
system is widening.
Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration’s investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I’d point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should–Matthew Holt
On Dec. 19, we published an Open Letter to the Obama Health Team,
cautioning the incoming Administration against limiting its Health
Information Technology (IT) investments to Electronic Health Records
(EHRs). Instead, we recommended that their health IT plan be rethought
to favor a large array of innovative applications that can be easily
adopted to result in more effective, less expensive care.
response to that post was vigorous. We received many comments and
inquiries from the health care vendor, professional and policy
communities – urging us to provide more clarity. One prominent
commentator called to ask whether we, in fact, supported the use of
EHRs. We both have been active EMR and health IT supporters for many
years. Dr. Kibbe was a developer of the Continuity of Care Record
(CCR), a de facto standard format for Electronic Medical Records
(EMRs), and has assisted hundreds of medical practices to adopt EHRs.
Dr. Klepper has been involved in EMR projects for the last 15 years,
and the onsite clinic firm he works with provides every clinician with
a range of health IT tools, including EMRs.
It seems likely that the Obama administration and Congress will spend a significant amount on health IT by attaching it as a first-order priority to the fiscal stimulus package. We take the President-elect at his word when he recently said:
“…we must also ensure that our hospitals are connected to each other through the Internet. That is why the economic recovery plan I’m proposing will help modernize our health care system – and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year.” (December, 6, 2008)
Whether the health IT money is well spent will depend on how it is distributed and what it buys. Most observers suppose that federal health IT investment dollars will be used to help doctors’ offices and hospitals acquire and implement electronic health record systems (EHRs or EMRs). These are commercial software suites for entering, storing and managing patient health data within a practice or health organization.
2. Software as a Service providers – SaaS providers offer lower cost of
ownership and faster implementation than traditional software
3. Open Source – I’m embracing Open
source operating systems, databases, and applications as long as they
can provide the reliability and supportability that I need.
4. Green IT – Winners will be innovative techniques to adjust power draw,
such as idle drive management, cpu voltage adjustments, and high
efficiency power supplies.
5. Cloud Computing offerings – These
are remote infrastructure utilities such as storage and high
performance computing. Friday’s Cool Technology of the Week will
describe a new technology called Cloud Optimized Storage.
I am deeply honored and profoundly grateful to be recognized, along with my brother Steve Shreeve, as the 2008 winner of the Linux Medical News Freedom Award. While this is a niche award in a niche space, it is highly symbolic in recognizing individuals who are “crying in the wilderness” regarding the promise and potential of open source within health care.
The award comes with the bitter irony of course, in the history and
historicity of the events which have led to it being awarded. On the
positive side, Medsphere was
born as a revolutionary force within the Health Care information
technology world. The company was founded on the premise that open
source could have a similar impact within health care as it has had in
other major industries of lower costs, improving quality, and
delivering more value. The open source approach has a particular
kinship with health care, as the notions of price sensitivity, peer
review, open collaboration, and transparency are desirable attributes.
I have discussed this at length before in many forums, and I see that Medsphere is still using our same slides to describe this connection.
In the past several months, there’s been some wringing of hands and some
pronouncements of glasses-half-empty concerning health reform and technology innovation.
For us glass-half-full types, here’s something to consider…
Roughly 15,000 physicians in the state of Michigan began to electronically link up this week. The new online service has been developed by Covisint, whose roots are in the automotive industry. Covisint’s client is the Michigan State Medical Society, which looks to the new MSMS Connect network to enable the state’s 15,000 doctors to do e-prescribing, secure messaging, and practice management online. You can learn more about the project here. Covisint is a subsidiary of Compuware.
The service will be live to all on January 1st and will be free to all practicing physicians in the state of Michigan.
Nothing focuses the mind like an impending hanging. — Samuel Johnson
I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.
The worldwide video gaming industry is a thriving business – with hardware and software sales reaching 43.5 billion in 2007 and projected to grow to more than 61 billion in the next 4 years. This growth isn’t propelled by just the latest teenage gaming craze, but by a variety of nontraditional organizations integrating video games, immersive simulations and virtual worlds to improve effectiveness and engagement across all business lines.
The October release of a new book, Changing the Game: How Video Games are Transforming the Future of Business, underscores this notion that video games are becoming a valuable tool for mainstream business. Used for everything from marketing to training to increasing productivity, “the evolution of video games has definitely given companies the ability to create virtual sandboxes that can provide a competitive edge.” As importantly, gaming can also create opportunities to reduce costs and increase profitability.
It may be surprising to some that the health care industry has been among the first to recognize the ‘game-changing’ potential of games in business and other environments. Leaders in the health care sector are now embracing video games as an integral part of a digitally enabled health culture.
If you don’t have an avatar, you may want to seriously think about creating one. I
am. I’ll admit it, at first I was skeptical, but the more I see the
benefits of virtual worlds, the greater the value and potential I can
see for health care.
An Avatar, as Wikipedia notes, is “a computer user’s representation
of himself/herself or alter ego.” (Hmmm, wonder what Joe the Plumber’s
avatar might look like)…
Second Life is the most well-known virtual world with more than 13
million registered users. It is primarily a social environment with a
strong creative component, since any user is allowed to create content
within the world. This highly-modifiable environment makes Second Life
uniquely suited to educational campaigns. For example, a space could be
created to simulate the everyday difficulties that people with mobility
challenges (i.e., people in wheelchairs), cataracts, or
diabetes-related eye illnesses face to help educate those without these
Whyville is an educational virtual world geared towards preteens and
children (ages 8 to 15) whose goal is to engage its 3 million users
across a broad array of subject areas, including healthy living, art,
history, and social issues. One could imagine an opportunity for
multi-generational education by creating “DiabetesTown” within Whyville
that would educate users about the importance of proper diet and
exercise, regular vision screening, and what life is like for friends
and relatives with diabetes.
THCB Note: Alice Kreuger recently updated THCB about all the exciting things she’s doing in Second Life on Virtual Ability Island. Here is a quick rundown. If you’re unsure about second life, check out this video.
We just opened Virtual Ability Island, which is accessed through our Web site. Newcomers with disabilities can come directly to the island from the site, including opening a new SL account and creating their avatar, entirely bypassing the Linden Labs orientation facilities.
Our innovative orientation facility is disability-friendly, and the instruction there is divided into two parts, beginning and advanced. The beginner course covers six basic skills that can be learned and practiced in an hour. The instructional sequence for newcomers is linear, provides embedded practice, and is based on principles of andragogy, the theory of adult learning.