Slow cooking always tastes better
Last week President Bush set forth a mandate of sorts for the healthcare community to cooperatively develop a centralized electronic health records database. He also suggested that Medicare, as the largest healthcare consumer in America, should lead this effort. Cynicism and partisan politics aside, when this happens it will be a good thing. But you can’t give much credit to a person standing at the sea shore telling you that the tide is about to start coming in. Ask any technologist and they’ll agree that we all see this coming. It is part of the intended evolution of technology to replace paper filing systems.
As it was with the Internet. Everybody knew computers would eventually revolutionize worldwide communications. Networks and modems got faster and more secure, universities started connecting their networks to share information, several types of electronic mail were created, even the military was in on the action with ARPANET. Now we have the World Wide Web — something we all saw coming but had no idea what it would look like when it got here.
My real problem here is the pressure of the imposed 10 year timeline. With the Internet we could have never set out to create what we have. The beauty of the system is that it evolved through natural selection: some technologies worked and got stronger, some didn’t and faded away. Years ago the realestate industry tried to revolutionize their MLS system hoping to transform the old phonebook-style registry into to nationwide searchable database. They forced a solution rather than letting one grow with technology and are only now catching up with other similar systems like Autotrader.com and Rent.com
A centralized medical records system will be the Internet of healthcare. As such issues like ease of use, accessibility and cost of entry will be paramount to its success. Trying to build such a thing in one fell swoop will result either in a severely limited system that is too reliant on old thinking or an overbaked ‘cutting edge’ system that is so complicated it gets in its own way.
A collaborative called ‘Connecting for Health’ published some good ideas:
Creating a loose technical framework: “a non-proprietary network of networks to support the rapid acceleration of electronic connectivity that will enable the flow of information to support patient care.”Addressing financial barriers: “The development of financial and other incentives and related processes to promote improvements in healthcare quality through the adoption of clinical applications and information exchange based on standards. ” Engaging the American public: “Informing the public with a consistent set of messages to be used by government, healthcare, and consumer leaders to promote the benefits of electronic connectivity and to encourage patients and consumers to access their own health information. ”
These are identical to concepts that were critical to the development and proliferation of the Internet. They all rely on careful introspection and patients. While I admire this administration’s attempt to support such an initiative, their contribution is more likely to be that of a bull in a china shop. If they really want to help they should start by establishing grants to fund private and institutional research that can investigate and develop these new technologies. In the long run something far better than we can imagine today will emerge.
