Monday, April 18, 2011

What Can An iPad Scrabble App Teach Us About HIT and EHRs?

It sure isn't easy being a President nowadays. Arab potentates have the bad taste to not know when they've been conquered, U.S. Treasurys could be downgraded, the U.S. air traffic control system literally takes naps from time to time and the health care reform debate refuses to go away. ACOs, the centerpiece of the "bend the curve" potential of the Affordable Care Act, may end up not having much of a reach or be readily embraced by physicians.  And in the middle of all that consternation, the Disease Management Care Blog was confronted by an additional lesson on the limits of the Administration's investments in health information technology (HIT).  The DMCB was visited by two of its spawn this weekend, who spent a pleasant afternoon on either side of the living room sipping chilled beverages. Playing Scrabble.  Remotely.  Over the Internet.  Using their iPads.  The only recognizable human interaction was the trash talking.

How... cool.

Which may ironically be more bad news for the Feds' efforts to promote use of electronic health records (EHRs).  Go to this CMS web site and it's clear that the vision underlying EHRs is an encounter-based system involving providers who maintain a central repository of patient-specific information and use that "platform" in "meaningful" ways. The Stage 1 "meaningful use" (MU) criteria outlined here confirm it's all based on a standardized and traditional clinical approach.  In that MU world, key information (problem lists, medication history, health screenings) is  maintained, followed and shared among the providers with a need to know.  It is very specific, measurable, transactional and reductionist.  Instead of an old-fashioned Scrabble board, it's on a monitor - but it's the same old game.

It is also ill-suited to the attitudes and lifestyle of the future patients who took over the DMCB living room.

While experts flittering about the "HIT space" refer to "ecosystems," the DMCB suspects that description may be far more apt than is generally appreciated.  Ecosystems are not linear, they're complex with interactions that are greater than the rum of their parts. This is where denizen patients and providers use multiple technologies reliant on rapidly evolving portable platforms to collaboratively and bidirectionally interact in real time.  Problem lists are jointly agreed to, medications are ever-shifting and health data are being constantly updated.  Docs will not only need to personally interact with their patients, but docs' portable information-devices will be syncing with their patients' while decision logic spins in the background.  Think about seeing a doctor as the two of you initiate your devices and trigger a dedicated and shared "app."  That is a truly new version of Scrabble.

Of course, the IT weenies will argue that EHRs need to learn how to crawl before they can run.  The DMCB agrees, but wonders if CMS' heavy handed involvement is forcing the system to crawl over problem and medication lists, while EHR-enabled interactivity remains the exception and not the rule.

Undoubtedly, minds far more creative than the DMCB's and the government's are already pursuing a new "Scrabble-oid" HIT paradigm. When they achieve a workable model, will the MU's specific, measurable, transactional and reductionist maintaining, following and sharing of problem lists, medication lists and health screenings get in the way? 


Otto Wolke said...

Could be you have something with those comments, but is it too complex and perhaps as in Dx Mgt there should just be a few parameters, that actually manage behavior or show behavior that can be changed to improve health status??Be interesting to see what societies that have implimented smart cards have done?? Otto

Jaan Sidorov said...

Otto Wolke raises a good point. From an outcomes perspective, measuring the "granularity" of a doc-patient Scabble-like encounter defies measurement. I suspect that if it is used, however, that patients coming out the other end will be far better off than patients relying on clunky EHRs. The nice thing about DM is that it is relatively "EHR agnostic."

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