Health Information Technology: Visioning vs. Planning

A recent study in Health Affairs confirmed what health providers and their patients already know: During a typical patient, the health care professional spends more than half of his or her time staring at the computer, not talking face-to-face to the patient. As of 2015, about 96% of health care organizations have a certified electronic health records (EHRs), and by the end of 2013, 66% of physicians were using electronic prescribing. Just ten years ago, those numbers were much lower, with only 9.4% of hospitals using a basic EHR and only 7% of physicians e-prescribing. Behind the push to get hospitals and physicians using health information technology was the promise of using big data.

While there have been volumes written about this has worked well in some ways, and not so well in others, what is undeniable is that health care organizations, and the patients they serve are now digitally intertwined. It is unlikely the system will be going back to paper-only records any time soon, so are there ways to make health information technology (HIT) work better?

One point of view was recently published by Family Medicine for America’s Health (FMAHealth) which focused on what primary care physicians want from HIT. They argue, “in addition to putting up barriers to achieving the Triple Aim, the poor usability and utility is resulting in health IT contributing to the growing problem of physician burnout.”

After a one day Visioning Summit, FMAHealth put forth a vision based on the following design principles: HIT should:

“(1) foster connections among health care professionals, including the individuals and communities they serve, and the environment in which people live;

(2) accumulate and analyze data that can support these connections and address the needs of population health; and

(3) promote appropriate payment for health care.”

The vision is set forth in 1, 3, 5 and 10 year increments. For example, in one year, the group would like to see “Data visualization technologies, which make it easy for the clinician to see patterns and make insight, will emerge to support health-related decisions and actions.” In three years, technology will “provide easy ways to natively support healthy behaviors, such as improved diet and exercise…”. In seven years, the group hopes “We will effectively use technology to deliver meaningful and relevant health-related information at the right time in a way that is “frictionless” and supports bringing the joy back to the practice of medicine.”

In my opinion, HIT is capable of all kinds of things, many of which I am sure we only starting to understand. Bringing joy back to the practice of medicine might be really difficult, but FMAHealth is putting forth a vision, not necessarily a plan.

Leave the plan to the Chief Information Officers (CIOs)!

Considering all of the money, time and human resources invested in HIT, some CIOs argue that hospitals, health systems or large provider groups are essentially health care shops AND software shops. David Chou, CIO at Children’s Mercy Hospital in Kansas City, MO [check it is MO] explained, “the day you made that investment you became a software vendor.”

What are some of the ways to make this technology work better, according to these experts?

·       Think like a software vendor (hint: clinicians are your customers!)

·       Have a strong focus on the end user

·       Use an iterative model to develop, test and get feedback from users

·       If you can’t buy it, build it (don’t hesitate create a capability that works for your organization)

No matter our daily work – as policy makers, business owners, health care professionals, or patient advocates, we should all be focused on the end user, and on iterating. As the health care system continues to change, looking to some of the lessons of the fast moving and customer-focused industry of software development could be a great playbook to follow to improve HIT.