The future of health care IT: Temper your enthusiasm, but not your optimism

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People often ask me what the next five years of health care technology will bring. As I start to explain what I think it will look like, I like to turn people’s attention to the recent past.

During the second Bush administration, a man named David Brailer was given a budget of zero dollars and asked to revolutionize health care IT in America through the establishment of the Office of the National Coordinator for Health Information Technology (ONC). Despite his budget limitations, David came up with four powerful ideas:

  1. Turn health care from a paper-based industry into an electronic one
  2. Do more to engage patients and families in their care
  3. Measure quality and manage the health of population groups
  4. Share data across the health care ecosystem

These four powerful ideas have now percolated across five ONC national coordinators and two presidential administrations. We are still pursuing these goals today, in fact, and the good news is we are making some progress.

Health care: the home of fuzzy data

Sharing data is still a struggle in health care, in part because a standard definition of terms is still extremely challenging. If I hear the word “fever,” I think of that as a temperature of 101.5 for greater than a 24-hour period. You might say, “I have chills, I feel sweaty, I have a fever.” Compare that to how straightforward it is to share information in finance because we know, for example, what a dollar is.

Do you think I can take a desktop running software to 450 different locations? Doctors and nurses are mobile people. They want to use the phone. They want the iPad. They want the technology clients they are accustomed to as consumers, and they want the services to be cloud-based.

Another example: there are five Maureen Kellys in the South Boston neighborhood of Boston, all born on the same day and the same year. And the problem we had at BIDMC was, according to our records, over the course of the past year Maureen had three kidneys removed, a brain transplant, and twins. Clearly, there was no unique personal identifier that could be leveraged to show five Maureens rather than one.

Despite health care data’s often amorphous qualities, we have made progress over the past decade in sharing that data across the ecosystem of payers, providers, and patients.

For example, we have begun to share more data with patients and get more information from them as well. At BIDMC, we have been sharing notes with patients since 1999, including medication lists, lab tests, and problem lists. When we started sharing notes, we heard a lot of naysayers talk about people finding mistakes in data, litigating about them, and creating fractures in the doctor-patient relationship.

Exactly the opposite happened. People found mistakes in the health care information but corrected them so bad things didn’t happen. Litigation decreased. And the bonds between doctors and patients grew tighter, not weaker. Shared efforts reflected in care team plans have become more the norm.

Health care and the cloud: an ideal pair

But has all the data grown too “big?” After all this time I still have no idea what big data is. I have four petabytes of data. Is that a lot of data? I certainly don’t have any problems backing it up or using it. To me, the important thing is not the size of the data, but turning the data into wisdom. Giving a doctor 10,000 normal measurements from your at-home blood pressure cuff is not so helpful. Telling the doctor that your blood pressure has seen a sudden increase after being normal is interesting.

That is why our true challenge in healthcare is visualizing large amounts of data. How do you send a request to clinicians or care team members about an action that needs to be taken and not just overwhelm them with raw data?

You hear the word “cloud” a lot as a potential savior for many businesses, but in health care, it really is starting to have an impact. I support 450 locations of care today. Do you think I can take a desktop running software to 450 different locations? Doctors and nurses are mobile people. They want to use their phone. They want the iPad. They want the technology they are accustomed to as consumers, and they want the services to be cloud-based. That way, the data is available anywhere at any time, whether they’re traveling to China or Chestnut Hill. Vendors are responding, too. Who would have thought a few years ago that Gmail might be the way to email your doctor securely? That's what we see in the evolution of mainstream companies creating mainstream health care applications.

We have come a long way in health care over the past decade, but how far do we have to go? One metric is to recall yourself as a patient and the amount of time your primary care physician spent staring at a keyboard (versus looking at you) during your last visit. BIDMC have told doctors you have 12 minutes to see the patient, but you also have to enter 141 structured data elements, be empathetic, and never commit malpractice. The only problem? That’s not possible.

If you were to ask the customers, the doctors and patients, how well we have done in health care IT after $35 billion was spent between the Bush and Obama administrations, they would likely say, “Not great. I’m not interacting with my doctor the way I want to, and doctors are miserable because they go home at 6:00 p.m. and then spend three hours after dinner doing documentation.”

Clearly, we can do better. As an industry, I believe we are moving toward a time when we’ll all be focused on outcomes and ensuring that patients are achieving wellness. So I look to the next few years with optimism because I think we’re going to see several things:

  • New mobile devices and cloud services that make delivering and receiving care easier
  • Patients, families, doctors, nurses, and pharmacists working better together as teams
  • More wins in the security sphere, though we'd all do well to remember that the best security is only as good as the most gullible employee
  • The alignment of economic incentives to start paying the health care system for wellness at home rather than sickness in the hospital

Let there be naysayers. In short, there are always ways to break through and develop better outcomes. Patients want it, doctors want it, and as a nation we all deserve it.

John D. Halamka, M.D., is chief information officer of the Beth Israel Deaconess health care system, senior vice president of information systems at Beth Israel Deaconess Medical Center (BIDMC), and a practicing emergency physician. He is also chairman of the New England Healthcare Exchange Network (NEHEN) and a full professor at Harvard Medical School.

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