Monday, November 2, 2009

Health Informatics specialists are essential to reform and transform our health system

Much of the American health system is outdated, inefficient and excessively expensive. Many have written about what is wrong with our system, and how important is the process of health reform. But relatively little has been written about what is required to improve the care of all Americans, and how we are to arrive at comprehensive solutions that both disrupt our current system of care, and replace it with improved approaches. One thing we can be certain about is that any changes that we make will be dependent on our capacity to harness information technology, and to use computerized systems intelligently to reform and transform our patient care environments and processes.

Clayton Christensen, in a recent ground breaking book, has argued that disruptive innovation is now necessary in our health industry and that this consists of three elements. The first requirement is for sophisticated technologies to simplify healthcare processes, the second is for business models that deliver more affordable and patient focused solutions, and the third is a commercial and information infrastructure to act as a value-added network.

For this vision to be implemented at a practical level, his model requires strong leadership and the training of substantial numbers of health informatics and change implementation specialists to take up transformative roles within our healthcare system.

Let's look at how this model might work for the average American academic medical center currently trying to provide a full range of sophisticated medical services while using our antiquated and exponentially increasing fee-for-service cost model, and running a series of regional primary care clinics.

The first element is to implement sophisticated technologies to simplify healthcare processes. This includes a full electronic medical record, accessed by patients and clinical staff, available anytime anywhere, sharing data with competitors systems, fully available for research and clinical trials and including a sophisticated set of decision rules to assist all users. This academic center would have extensive telemedicine and internal and external communications systems, online platforms for all types of continuing education, and an active virtual community profile and social networking program. All of the technologies would be continuously improved and evaluated by a team of health informatics specialists, part of whose role is to train their colleagues and the next generation of change implementation specialists.

The second element is to transform the clinical and cost-approach taken by the medical center which will need to focus on specialized areas of internally acknowledged strength to become, as Christensen notes, a "solution shop" in its areas of strength, while no longer providing a full range of all types of medical and surgical services. This may mean dropping certain types of care completely, and negotiating for such specialist services to be delivered at another hospital instead. It may mean creating specialist community clinics with capitated payment models. It will certainly mean doing more of what it does well, and less of what it does not see as core clinical activities. It means taking on services that are already efficient and technologically supported, and adding value to these services through technological and clinical innovation. This second element requires both business and technological expertise.

The third element in the model is developing what Christensen calls "facilitated networks" which he defines as enterprises in which people exchange things with each other. This is where the academic center might decide to partner with previous competitors, promote pre-paid preventative health approaches, support health savings accounts linked to employer groups and encourage all patients to have personally controlled health records. All of these activities are underpinned by the need to have extensive expertise in health informatics - the discipline that is, above all others, required to transform American healthcare.

So the question is, can a modern academic medical center in the USA afford to be without a strong health informatics program as it moves forward in this era of health reform?

And the answer?

A resounding "No".

Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.


  1. For HI organizations, I go to HIMSS
    you can get a global look at where every vendor is in this industry in the whole world.
    There is a very nice patient record simulation that you can play with, when you sign up
    to become a member of HIMSS. You can design your own model/ product with that
    data base. Who knows? that's the beauty of HIMSS, you can absorb all the ideas from
    this organization, and see who will design a better and better system.
    I like this kind of evolution.

    I also constantly check on
    In this wiki, you can see many links to what's the new and essential stuff.
    Well, like I said, I'm not too crazy about the EHR.

    But I'm very crazy about the engineering of the gadgets for telemedicine.
    I once joked with other nurses that I want to have a kind of RF( radio frequency) bracelet
    that takes vital signs of patients and automatically update to the patient records.
    The technology is there, once stuff like this will be invented and in production,
    you can imagine that there will be a new nursing world. (both evil and good)

  2. O, I'm not talking about the primitive version of RF bracelet, because it is just for patient tracking purposes. I want the integration of the functions of taking vital signs (BP, HR, Resp., Temp, O2 sat, Na in sweat, etc...), then transmit to patient records.
    If I can be involved in this type of project, go figure...I'd love it, this is the combo of EHR, telemedicine, engineering and nursing. ^_^

  3. I said I'm not crazy about EHR, because software companies, hospitals, insurance companies and the public sector still have a long fight ahead in their turf wars. In 2018, maybe, see if there will be a unified system can be adopted universally.
    On the other hand, I'm really really really crazy about mHealth. And this is the reason why I'm so crazy about UC Davis. I think UC Davis medical school leads the country in rural medicine, and the rising star in rural medicine is mHealth. (
    (sorry, I just have that urge of finding the cheapest way of delivering the quality health care.) ^...^

  4. I want to go to AMIA 2009, at least for one day. "Innovation & Information Center Open (Nov 16 - 10:00 am to 1:30 pm & 3:15 pm to 7:00 pm)"
    But I'm new to NorCal, it's scary for me to drive there alone. I'll still be there no matter what, but the registration fee is hard to swallow.

  5. enlightened, brightened, global technology leaders conference today.

    Intel former CEO proposed (and will fund) for an MBA program at UCSF/UCB for medical professionals and engineers in translational medicine. (translating technology into cost-effective healthcare).
    (Andy Grove, extremely honest, perceptive, concise, and cutting to the chase, in a funnest way.)

    Safeway CEO presented the Safeway model of health insurance, great ideas have proven
    working greatly...He brought along union members with him, what a perk. ^_^
    (Steven Burt, amazingly practical, evidence based, and humane... the same presentation has gone to the 500 CEO conference, the congress and White House. The presentation is not to be published because some data used can really bring down a few companies in the healthcare industry.
    Luckily I have taken photos of most of the slide.)

    Bright, bright people from NIH, Cisco, Microsoft, Qualcomm, genome center, lawyer,
    medical and health entrepreneurs sitting in two sessions of the discussion panels. One is for
    disease detection, another one is for medical devices, both are focused on lowering cost in healthcare.
    Audience came from all continents have asked great questions.
    There was a live broadcast on the universities' website, and on Twitter.

    Unexpectedly, the man sitting next to me at luncheon was the inventor of a single most important and a most widely used hospital monitoring device: pulse oximeter. Of cause
    he is not a young man, but just as bright and sharp as he has always been. I asked him how can I invent the stuff I suggested, he right away said, "no, not possible". "Why?". "Accuracy..." wow, at least he still knows anatomy and physiology better than I do. ^_^