Andy Oram in O’Reilly Data: “There is no dearth of health reformers offering their visions for patient engagement, information exchange, better public health, and disruptive change to health industries. But they often accept too freely the promise of technology, without grasping how difficult the technical implementations of their reforms would be. Furthermore, no document I have found pulls together the various trends in technology and explores their interrelationships.
I have tried to fill this gap with a recently released report: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. This posting describes some of the issues it covers.
Take a basic example: fitness devices. Lots of health reformers would love to see these pulled into treatment plans to help people overcome hypertension and other serious conditions. It’s hard to understand the factors that make doctors reluctant to do so–blind conservatism is not the problem, but actual technical factors. To become part of treatment plans, the accuracy of devices would have to be validated, they would need to produce data in formats and units that are universally recognized, and electronic records would have to be undergo major upgrades to store and process the data.
Another example is patient engagement, which doctors and hospitals are furiously pursuing. Not only are patients becoming choosier and rating their institutions publicly in Yelp-like fashion, but the clinicians have come to realize that engaged patients are more likely to participate in developing effective treatment plans, not to mention following through on them.
Engaging patients to improve their own outcomes directly affects the institutions’ bottom lines as insurers and the government move from paying for each procedure to pay-per-value (a fixed sum for handling a group of patients that share a health condition). But what data do we need to make pay-per-value fair and accurate? How do we get that data from one place to another, and–much more difficult–out of one ungainly proprietary format and possibly into others? The answer emerging among activists to these questions is: leave the data under the control of the patients, and let them share it as they find appropriate.
Collaboration may be touted even more than patient engagement as the way to better health. And who wouldn’t want his cardiologist to be consulting with his oncologist, nutritionist, and physical therapist? It doesn’t happen as much as it should, and while picking up the phone may be critical sometimes to making the right decisions, electronic media can also be of crucial value. Once again, we have to overcome technical barriers.
The The Information Technology Fix for Health report divides these issues into four umbrella categories:
- Devices, sensors, and patient monitoring
- Using data: records, public data sets, and research
- Coordinated care: teams and telehealth
- Patient empowerment
Underlying all these as a kind of vast subterranean network of interconnected roots are electronic health records (EHRs). These must function well in order for devices to send output to the interested observers, researchers to collect data, and teams to coordinate care. The article delves into the messy and often ugly area of formats and information exchange, along with issues of privacy. I extol once again the virtue of patient control over records and suggest how we could overcome all barriers to make that happen.”