Health IT as doctors’ aides
The history of health care information technology is a story about finding tasks technology can serve. When mainframes were the only computers, they assisted in managing financial processes. As mini-computers emerged, it became feasible to use the technology to create a digital version of the medical, which helped address the problem of records made unavailable while being transported around an institution. Microcomputers and networking technology brought forward even more opportunities to assist, and some would hope improve, health care delivery. The question has always been, “How can we make computers and technology useful for health care?” Couple technology advances with pressures to improve throughput efficiencies and to document billable events and we have today’s electronic health record systems (EHRs) and health information exchanges (HIEs) woven into the fabric of health care delivery in ways that are not uniformly positive.
As technology developed and its capabilities improved, HIT has been assumed to have clinical utility by giving doctors something they didn’t have before—instant access to all forms of a patient’s data. Today’s mobile devices offer the promise of organizing and displaying desired information creatively. According to healthit.gov, the number of doctors using electronic health records was 57 percent in 2011, an increase from 18 percent in 2001. However, the one problem health technology hasn’t solved in its evolution is becoming an interactive aid to help doctors better serve their patients in a hands-on way. For example, shouldn’t we use these powerful computing devices to understand a patient’s problem list, diagnoses and current medications to offer the clinical team evidence-based pathways of care? The EHR technology in use today was never designed to do so simply because the capabilities didn’t exist when this generation of software was being designed.
But now the technologies do have the power to become clinical support aids. Robert L. Wears’ article points to this issue. In “Health Information Technology and Victory,” Wears writes that the national health information technology policy has been an expensive failure. On one hand, he makes a valid point. But on the other hand, it’s popular for doctors to criticize EMR systems and the big health IT spending initiated by President Obama’s administration. It’s important to acknowledge that the big health IT stimulus spending was primarily done because the economy was in a severe recession, and the IT industry was ‘shovel-ready’, arguing that complete automation of health care would provide the information needed to support the Triple AIM goals underpinning the Affordable Care Act.
However, I do agree with Wears’ point that it’s time for a new generation of technology that helps doctors. Most of the technology we invested in through the ARRA HITECH stimulus does that because the systems weren’t intended to be tools that made doctoring more effective. Why? Because they were designed by young software engineers—not doctors. Wears argues, and I agree, that the people who provide the care need to collaborate and decide what types of tools they need to supplement their work. Having clinicians specify the requirements in minute detail will open the door for the software engineers to deliver on the promise of today’s advanced information technology.
That’s what the requirements method we follow at PHII is all about—we’re asking people how we can help them do their work. To progress, we have to first understand that the tools of today are not really solving the doctors’ problems. They solve the billing and transactional problem of moving data around and across institutions. But to improve the care patients receive and to support the providers of that care, it’s going to take a new generation of technology with public health and surveillance involved so that we all rise together.