HIT Think

Three important goals for health IT in 2019

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Healthcare is on the cusp of an exciting era. It’s been nearly one decade since the HITECH Act of 2009, which catapulted the electronic health record to national policy.

The more than $35 billion dollars that HITECH brought also included raft of unintended consequences, including physicians burned out by technology hassles, frameworks of abstract interoperability best practices and EHR checkboxes, and a general reluctance to challenge the status quo.

But newcomers have arrived. The post-EHR era has been heralded by disruptive, ventured-backed, technology-enabled provider groups bringing their own clinical experiences to the table, by the convergence of consumer technology and traditional health information technology (HIT), and by an interoperability environment rapidly shifting to networks rather than installations.

It feels like the right moment to ask ourselves what we actually want from HIT. As we move into an exciting new period of change, here is my wish list.

Use use cases, not frameworks
I tend to abhor technology built for technology’s sake. This approach is often filled with pyramid charts of layers, approaches and eventualities. “Interoperability” describes a feature of a system—the ability of an EHR system to share information with another EHR system—and is meaningless when considered in the abstract. What matters is the visceral.

Doctors have access to more information now than in any time in history. But in the race to make patient information digital, we’ve done a poor job of separating signal from noise and surfacing critical information at the point of care.

We must improve our ability to bring relevant information to the fore while suppressing distractions. That means understanding an eye doctor requires different information than an ER doctor. It means helping a doctor not only learn about the patient in front of her, but the patient she isn’t seeing that is in the most acute need of treatment. And for a doctor with a patient panel, that means surfacing information any time her patients are seen elsewhere or when their health status changes (alerted, perhaps, through smart devices in the home).

Here’s an example of how this is happening already: Several years ago, in a meeting with athenahealth’s clinical team, leaders from the American Congress of Obstetricians and Gynecologists expressed concern about the number of women with hypertension who, not yet knowing they’re pregnant, continue to use ACE inhibitors that cause serious malformations in fetuses. We ran a real-time query of the 63 million patient records on our network and identified 62,000 women of childbearing age who were prescribed ACE inhibitors—therefore at potential risk. We were able to alert these women’s doctors and suggest they prescribe a different hypertension drug or urge their patients to use contraception.

Open doors and open notes
My next wish is addressing what patients continue to tell us is their biggest frustration: the experience, administration, and annoyance in our healthcare system.

Let’s consider the inability to get an appointment with the right doctor at a convenient time. We can book a movie, a massage and a dinner reservation online, but we have no single service to find and schedule doctors’ appointments. In a recent Commonwealth Fund study, 52 percent of Americans said they couldn’t get a same- or next-day appointment with their provider when they were sick.

The good news is the upside for connecting unsatisfied demand to unused capacity is enormous—as is the upside for providers to see increased revenue and market share while serving the wishes of patients.

Unleash the app economy
Enlightened managers follow a truism: Most of the smartest people in the world don’t work for you. Open innovation has given us amazing things like the internet, GPS and sequencing the human genome. Yet, major HIT vendors today continue to try to solve every problem themselves. A single vendor can’t design a technological aid for diabetes, ophthalmology and other specialists with nearly the level of precision as a dedicated development team whose entire company is focused on said specialties. Medicine is specialized; so too should be the IT services that support it.

As systems open and an app economy emerges, entrepreneurs can invent the things we only dream of today—just look how market-driven models are transforming the way we shop, travel, meet and more. As data breaks out of individual systems and the network effect takes hold, we can expect to see exponential acceleration.

Unfortunately, major vendors are still working away—perhaps unknowingly—at building a walled garden of bespoke, comprehensive hardware. Let’s leave these monolithic, top-down solutions behind. We’re a country that has found success harnessing the power of plurality. It’s inscribed in Latin on our coins. We need a healthcare system as diverse, innovative and open as the economy it serves.

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