Last November 9 at 2 a.m., I received a phone call from a hospital in Southern California. “Your mother needs an emergency operation,” said the voice on the line. “Your father had chest pain while at her bedside and both are in ICUs. We have no idea what medications they take, what allergies they have, or what problems they have been treated for. Can you help?”
This is medicine today. A sea of paper and fax machines, information silos, privacy barriers, and unconnected data. And yet, we know the public is ready for a better system. According to a 2010 Harris Poll, four in five Americans believe any doctor treating them should have instant access to their medical record online.
Today, we are moving quickly in this direction. In 2009, President Obama signed the HITECH act, creating a $27 billion stimulus package to accelerate health-care information technology in the United States. The law pays doctors to adopt electronic records, and penalizes those who don’t. Fueling the change are data standards that make it easier to share health information, maturing software, rapid innovation linked to mobile computing, and policies to protect patient privacy. As a consequence of this perfect storm of incentives and disincentives, the next five years will see an unprecedented acceleration of electronic medicine in the U.S.
Other countries are moving along a similar path. Some wealthy nations with socialized medicine are far ahead; in the Netherlands, 98 percent of primary-care doctors already use electronic records. But most nations—including Japan and China—are just beginning to bring IT to bear on health care in a systematic way.
Will we solve the problem of runaway health costs? The health reimbursement system in the U.S. pays doctors and hospitals for how many treatments they provide, not how good that treatment is. In Massachusetts, for instance, I estimate that 15 percent of lab and radiology tests are redundant or unnecessary. Evidently, one man’s redundancy is another man’s country club membership.
An important aim of health-care reform is to change our broken incentive structure by instead paying doctors a yearly fee to keep patients healthy. For doctors to survive this reimbursement change, they will need to keep electronic health records, share data, apply telemedicine to monitor sick people at their homes, engage patients continuously, and integrate the latest treatment knowledge into their workflow. That’s electronic medicine.
The transformation of the health-care industry to embrace the levels of automation typical of travel and financial services will not be easy. Health care has unique payment models, referral patterns, workforce expertise requirements, customer needs, and privacy regulations. For these reasons, the centerpiece of the HITECH Act is the concept of “Meaningful Use”—paying doctors and hospitals only after they have installed electronic records and shown that they are using them wisely as measured by specific goals. Starting this year, your doctor will need to keep a computerized list of your medications, problems, and allergies. By 2013, your doctor will need to be able to share these data among all your caregivers (with your permission). And by 2015, the hope is that the combination of electronic health records, data sharing, and novel technologies will enable your primary-care doctor to recommend best treatments based on the experience of tens of thousands of similar patients.
Here’s my prediction for the major developments in the next five years:
Electronic Health Records in the Cloud
Doctors are great at diagnosing and treating disease. They are not good at server hosting, database administration, and implementing government data protection rules, nor do they want to pay for costly hardware and software. I believe the only way to rapidly implement electronic health records is via the cloud.
Cloud computing—storing data and programs in centralized servers rather than in the doctor’s office—requires novel security engineering to resist malware, denial of service, and sophisticated hacker attacks that could jeopardize private health information. But they solve other problems, such as making it possible for complex software to be scaled up and maintained without any technical involvement in clinician offices.
In the near term, regulatory requirements will result in the rise of “private clouds” hosted by large hospitals and software vendors, but commercial cloud providers are likely to develop secure hosting, given the enormous business potential of hosting electronic records for the more than 500,000 physicians in the U.S. At Beth Israel Deaconess Medical Center in Boston, where I am chief information officer, I estimate that moving infrastructure and applications to my hospital’s private cloud has reduced the cost of implementing electronic health records by half.
Modular Software Unleashes Innovation
Less expensive cloud-based software, combined with tablet computers, will unleash a wave of software innovation. Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones. Imagine a cool new app that provides a dashboard for diabetics, showing their daily glucose readings and sounding an alert if they aren’t managing their disease well. Doctors today must wait for their medical center’s single monolithic vendor to develop such an app. In the near future, modular software will let doctors and patients tap the creativity of thousands of entrepreneurs.
Consumer computing hardware will accelerate the new innovation ecosystem and bring it to the patient bedside. Already, over 1,000 clinicians at my hospitals have purchased tablet computers like the iPad and Samsung Galaxy Tab, using their own funds. Although developed for general consumers, tablets are proving to be an ideal computing device for doctors, too: they weigh under a pound, have a battery life of 12 hours (or about one shift), can be dropped five feet without significant damage, and can be wiped down with disinfectant.