President Obama's stimulus package is putting aside roughly $21 billion for healthcare technology and the development of electronic health records (EHRs). At this point when we say "billion" or even "trillion" it doesn’t have much of an effect. So let’s try that again – Obama's stimulus package is putting aside $21,000,000,000 for healthcare technology. It is a ridiculous amount of money.
But, where will it all go? Most of it is earmarked for the creation and utilization of electronic health records, which is essentially a digitized version of the chart a doctor keeps. But an EHR is intended to capture and integrate every chart, every test result, and every other piece of data. If all of a patient’s data is integrated into one consistent record, then doctors will be more empowered to make the right decisions.
I assume that most of the stimulus money will go to large technology companies that create complex database systems and algorithms to handle the intensity of data required to make it all work. However, I hope that the stimulus package carves out money to understand how data will actually get into these health records, and more importantly, how people will actually use them.
My doctor doesn’t have a computer in his office, and I question how soon he and his staff are going to put down their pens and pick up a keyboard during an exam. There’s also a tremendous amount of medical data that exists in non-clinical locations, such as at home and at the gym. How will this information find its way into EHRs? Personal Health Records, essentially EHRs owned and gardened by consumers, are thought to be a solution. But it’s unclear if people have the motivation to actually interact with these products on a regular, on-going basis. We will need to find a good way to get these systems to work within the needs, motivations, and behaviors of those that will actually use them.
At the same time, what is the point of collecting all this information in a single location if its not communicated back in a meaningful way? A centralized EHR would be extremely valuable to providers, patients, employers, payers, pharma companies, and so on. Each of these participants will want to use the information in a very unique way and also will have specialized needs and expectations for how it is presented. I am concerned that within the $21,000,000,000 there will not be enough consideration of purpose and usability in a real-world setting. As a result, many of the systems might end up largely unusable or wasted.
In all of this we must be cognizant of the real, and very sad, state of technology in most medical settings. Sure we have amazing scanners and procedures that are miracles of science and engineering. But the state of technology that is actually usable by regular, real people (patients, under-educated nurses, and doctors are real people too!) is shoddy at best. As I mentioned, I don’t envision my doctor entering my results into an iPhone app anytime soon.
This is literally the patient point of view...
It is a photo from my doctor’s waiting room. Notice the two displays. One is an 80's or possibly early 90's era CRT – it is not even on. The other is a flat panel display, rather small, that cycles through a bunch of mundane content. This small, glorified billboard only presents extremely basic health tips (e.g., wash your hands!) and generic multiple-choice trivia questions that have no value at all. My local bodega has better and more interesting content on a 40” LCD (thanks to Danoo)!
In a waiting room, we have a captive audience that is thinking about health issues because they’re about to see a doctor, yet there is nothing to help the patients. There is nothing to help people get ready for a visit to maximize the time with the doctor. There is nothing to help review past records or streamline the process in any way. What an amazing time and place for people to interact with their EHR! But there’s nothing even close to being on the right path for that. Technology is non-existent here, so a massive EHR system would be equally useless.
So we can spend $21,000,000,000 on EHRs and other healthcare IT, but we have a long way to go if we want technology to actually make a difference in the settings that matter most. We have to look at how patients, providers, and everyone else will actually use and interact with this information. We must design for the moments and use cases that will take data and make it interesting.
Hopefully some of that $21,000,000,000 will look at these human-centered issues. Otherwise it will be such a waste.