Thursday, April 9, 2009

Amazon.com to Build New EHR

Amazon.com announced today that it will develop a new Electronic Health Record based upon the same user interface experience and underlying information technology that it uses to support its global ecommerce business.

Said Amazon braintrust, Jeff Bezos, “Our experience with user interfaces and high performance computing are ideally suited to help healthcare. We nudge people’s decision making and behavior with the gentle push of data. When you buy a book on Amazon.com, your user interface is different than my user interface when buying the exact same book. Amazon generates the user interface based on the analytics of the broader context of the customer’s profile, purchasing history, geographic location, and other similar customers’ profiles. The parallels in healthcare are numerous and obvious, such as, “Other physicians who treated this type of patient also ordered these other medications” and “Read how other similar patients rated this treatment protocol” and “These are the other physicians in your social network who treated patients like this most often” and “This MRI is in stock and can be schedule immediately” and “This medication is available at your patient’s preferred pharmacy. Here are some other options and costs” and “Add this patient to my Diabetic Registry” and “Add this patient to my Watch List.” In addition to our unique Amazon user interface, we also have a very flexible, open services oriented software architecture that allows us to work easily with our partners and adapt quickly to changes in the market-- and our systems perform—they are fast and never go down. We will also bring this technical skill set to healthcare, which is hampered by stodgy, unreliable systems that are integrated with fragile message-based data interfaces. This foray into healthcare is not about Amazon. It's about our one billion customers and 21,000 employees. ”

The Amazon story is a spoof, though I wish it weren't. :-)

Lots of us have been planting the seeds of change around the certification of EHRs; that is, they should be certified on something more than simply interoperability-- namely usability, patient safety, and an EHR's impact on quality of care, efficiency of care, and cost of care. Future EHRs must blend patient treatment, patient management, and patient economics in the same user interface, and that EHR user interface must be dynamically generated to suit the personal context of the patient, the provider, and the healthcare system at the provider’s and patient’s disposal. It doesn’t do any good to suggest an advanced and expensive lab test in an EHR’s decision support system if the patient can’t afford it or the healthcare setting is in a remote clinic of the Navajo Nation with no lab facility.

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