Improving EHRs: Isaac Kohane, top, and Kenneth Mandl say that the designers of electronic health records (EHRs) could learn something from the iPhone.
Bachrach Photography, Joon Lee
Open programs to third-party developers, say two tech-savvy physicians.
Thanks to the $19 billion designated for health-care information technology in the recent stimulus bill, electronic health records (EHRs) have garnered a great deal of attention in the past few weeks. The bill sets aside $17 billion in incentives for physicians and hospitals that use qualifying EHRs beginning in 2011, and $2 billion for the development of standards and best-practice guidelines over the next two years.
The bill does little to specify the types of technology that health-care providers must use, leaving the details to a newly appointed national coordinator for health information technology. Given the amount of money at stake, both EHR vendors and the medical community are anxious to see exactly how these details will unfold over the next two years. In an article in the current issue of the New England Journal of Medicine, physicians Kenneth Mandl and Isaac Kohane outline their prescription for creating an effective EHR system. Their approach is modeled on successful IT products outside of health care, including the iPhone and Facebook, which rely on innovative applications from third-party programmers. Mandl and Kohane propose what they call a platform approach, in which EHR vendors sell a flexible, basic platform that is designed to work with components from other vendors, much as the iPhone works with applications made by a myriad of third-party developers.
Mandl and Kohane, both members of the Harvard/MIT Health Sciences and Technology Program at Children's Hospital Boston, spoke with Technology Review about why their approach is crucial in digitizing health care.
Technology Review: Why should EHRs be more like the iPhone?
Isaac Kohane: On the iPhone, if you don't like how an application does a particular task--managing a to-do list, for example--you can download one of ten other available task-management software systems. That's because Apple created a market for third parties to create new applications. Consequently, better applications are being developed, creating a competitive market.
TR: How does that compare with health-care IT systems?
IK: The contrast is stark. Most existing programs are these big monolithic applications designed to solve all the challenges and tasks that developers conceived there to be at a hospital or doctor's office. If the practitioner doesn't like a specific thing, they can't replace it. They either have to tough it out and deal with a system that doesn't fit their needs, spend lots of money and more time with the vendor to customize the application, or throw out the whole system and start again. We know from the iPhone and Facebook and their widgets that this just isn't necessary.
Kenneth Mandl: We have to assume that we don't know what functionality we [will] want five years from now. We need to build a system that will evolve with our thinking, with our science, and with our health-care system.
Medicine today is a sea of paper and fax machines, privacy barriers, and unconnected data. The public is ready for a better system.
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While the model of creating independent modules that can access a platform of core functionality is appealing in that it provides a constant stream of innovation, the regulatory and security requirements around this sort of information may make this a bit more complicated than creating an app that manages a to-do list. Also, I believe that the involvement of government agencies will be an onerous burden on small companies that we would rely on to develop these tools. That said, the existing EHR companies should take note and re-think how they develop their software and how they embrace and enable small 3rd party development organizations.
Throwing money at such a high impact public service would not bring innovation. How about learning some lessons from NHS (UK). Too often private sector exploits the public purse to the detriment of delivering value for money.
iphone is a great connectivity and viewing platform but
EHRs seem to be a database/security issue on the very back end and a brokered middle level based on web technologies and human (medical professional) filtering that enforces industry and government processes. Existing systems are proprietary throughout, but the real solution should be open standards based and vendors should compete on the middle layer; this approach will help to keep costs down and innovation up. I'm sure a few students could model solutions.
Just like we knew we should have contracted Disney to build mass transit systems like at Disneyworld, we should have Apple honcho healthcare records. Everybody can be given an iPod to keep all their medical info in it and all the Doc needs to do is Sync in reverse!
YOU THINK I'M KIDDING?????
This issue of integrated IT systems vs some user-driven amalgamation of the best of the best is as old as IT management itself. Efficient, effective IT systems need consistent data definitions and processes. In business, the lack of satisfaction with IT systems often betrays a lack of agreement on the business processes per se. It is difficult to get assertive, competent professionals to come to agreement with each other on the proper business processes and data meanings. The morass of medical systems, financial systems, reimbursement systems, and quality systems will never get better without new leadership that can stand back and look at the whole problem. New iPhones are not the solution.
Guest (ronnie.williams)
The following link shows some security issues which are currently in an iPhone.
http://www.technologyreview.com/communications/22782/
That means the iphone apps can be cracked and run on any iphone model and firmware version.
this should be an important point while designing an iphone app at such a major scale !
Manufacturing in the United States is in trouble. That's bad news not just for the country's economy but for the future of innovation.
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olechief
1 Comment
EHR
While the concept is very desirable, the execution will leave a lot to be desired. In an era of HIPAA security, how do I assure that my EHR are not shopped around for other purposes? How do we assure ourselves that the whiz-bang apps proposed are secure enough to protect my EHR? I have a very visceral sense that government control and access to my EHR will lead to a loss of choice in my medical treatment and a Canadian style of rationing to my detriment. Color me extremely cautious!
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