Wednesday, July 13, 2005

Not going to happen.

Will take a visionary well versed in information technology, user interface design, operations research...and the unique psychopathology of the physician. Not to mention the politics of health care economics. And it is indeed that...more politics than economics.

Unless all of these qualities reside in a single individual to lead the endeavor, the enterprise will fail. It may become implemented through brute force, but it will be no more than another bureaucratic hoop for the system to contend with.


Opening Health Care's Info Arteries; The key to better care is one standard for medical info, from doctors' offices to corporate giants. That demands a new level of cooperation.

Paul Horn
934 words
11 July 2005
BusinessWeek Online
Copyright 2005 McGraw-Hill, Inc.

Few will argue with the premise that innovation helps drive growth in the economy. And most people would agree that innovation isn't something one can pull off a shelf. To stimulate it, we must foster a climate in which new ideas can thrive.

Defining that ideal climate and then figuring out how to create it, however, is no easy task -- especially since the very nature of innovation is changing as we advance in this new century.

Given the complexity of our most pressing societal problems and the diversity of skills and resources required to solve them, innovation will increasingly require collaboration on a broader scale then ever before and draw upon the brightest and most creative minds across industry, government, and academia.

LESSONS FROM LINUX. Because innovation transcends the invention of new technologies -- it's the application of these technologies to some useful purpose -- it will require collaboration among creators of technology, those with the skills to apply it, and the beneficiaries of the innovation. Leaving out any element of that cooperative process will diminish the result.

Often, this task will actually involve a diverse group of interested parties, raising a Babel-like challenge: how to communicate effectively. The common tongue that will bind collaborators will not be English, French, Spanish, or Chinese. It will be standards: open business standards not controlled by any one participant. There lies the fuel behind the successful emergence of technologies like the Internet and the open-software movement as exemplified by Linux.

The best way to illustrate the potential impact of collaboration and open standards is through an example. What better example of an area ripe for innovation than the U.S. health-care system?

ISLANDS OF INFO. Calling it a "system" is being generous. In fact, a system is exactly what health care in the U.S. lacks. In its current incarnation, it encompasses thousands of mostly unconnected little islands of information, very few of which are even consistent in the data they store or the way they store it. The reason? Competing vendors' solutions, each of which is designed around proprietary technologies that the supplier hopes to establish as ubiquitous -- and then reap the benefits as a quasi-monopoly.

In reality, all health-care vendors are losing out on the opportunity that many could share if they reached some consensus. Developing a national health-information-technology infrastructure is actually an obtainable goal -- at least from a tech perspective.

But to succeed, all parties must come together to surmount many obstacles, ranging from agreeing on standards to guaranteeing privacy and accessibility of patient data. The information, usually an individual's medical record, has to be "liquid" -- that is, accessible when we need it and wherever we may be. Otherwise, it doesn't merit the effort.

AGREE, OR ELSE. Part of the problem is that the term "medical record" refers to the data embedded in clinical documents maintained by a variety of health-care providers, each of which typically uses its own proprietary archiving system to file and update medical records. There's nothing liquid about electronic systems that are proprietary. Handwritten paper forms are even worse.

The U.S. Health & Human Services Dept. has issued a challenge to the industry: Agree on standards, and figure out a way to make electronic health records a reality, or the government will impose standards unilaterally.

Rising costs are behind the push. The U.S. spends more than $1.7 trillion a year on health care. Estimates say electronic exchange of data could save about 10% of that. With the stakes so high, failure isn't an option. All the parties -- the payers, the providers, and the patients themselves -- have motivation to do this right and work together. But how?

REACHING ACROSS BORDERS. Perhaps the biggest IT challenge is achieving interoperability: What works within the walls of a hospital or an insurance company must translate across business models and environments, from the process-driven rigor of a large enterprise to the mom-and-pop environment of many doctors' offices.

For interoperability, open standards are a must. Efforts like the recently formed Interoperability Consortium, in which eight of the largest tech companies including IBM (IBM), have agreed to embrace open technology standards as the basis for creating a national health-care network, are already exploring the right way to build this infrastructure.

At IBM, we've also begun building a simulated electronic medical-information system in concert with partners from the health-care field to conduct research into collaboration across offices and geographic borders. We hope to find ways to resolve technical issues, test open standards, and accelerate deployment of such technologies and improve the effectiveness of the health-care system.

DEEP DATA. But perhaps the greatest reason for achieving health-care information liquidity focuses on the obvious: better health care. Substantial progress in innovative medical treatment, such as predictive medicine (helping patients avoid sickness long before any symptoms arise) and more targeted treatment (based on individuals' unique needs), depends on fully integrated health-care records. Without them, we cannot conduct the collaborative research and epidemiological studies crucial to a deeper understanding of sickness, wellness, and how to avoid the one while promoting the other.

As is often the case, we already have the technology. The challenge lies in applying a new collaborative model of innovation to create a radically new, and greatly improved, health-care system.


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