Monday, April 25, 2016

Too Late: ONC EHR Comparison Shopping Tools

This article from Healthcare IT News, "ONC offers 4 ways to build better EHR comparison shopping tools" highlights why ONC is becoming less and less relevant.

Simple Yelp ratings would be more effective than a bureaucratic rating system that was mandated by Congress and managed by ONC... but I think it's a little too late anyway, no? ONC and HITECH already doled out $30B of our tax money to create a false market demand and incentivize the acquisition of products that are generally considered frustrating to use, at best, infuriating to use for many physicians. The horse is already in the garden and the crop is stomped. The best that the ONC can do now is plant a new garden-- start focusing on and encouraging the development of next generation EHRs and clinical decision support systems so that in 8-10 years, when our hangover from the HITECH investments has worn off, there will be a crop of new products and technology that attract clinicians naturally to their use, no federally subsidized incentives needed.

In the meantime, ONC could also play a critical role in the development of data governance strategies for patient reported outcomes, healthcare cost accounting, the social determinants of health, familial history, clinical decision support algorithms, and clinical interoperability that is data-centric, not document centric. The data in today's crop of EHRs only accounts for 10%* of the data required for both population health as well as precision medicine (*--Alberta Secondary Use Data Project, 2015) and 0% of the clinical decision support that machine learning could provide.

ONC needs to salvage its value by jettisoning its current mindset and focus on today's EHRs-- that train left the station. It's time to look ahead, and with a new leadership at ONC under Kathleen Blake, no time is better than now.

Friday, April 15, 2016

Software Is Now The Leader of Change

Software has now replaced the heroics of individual human leadership as the greatest agent of change in human behavior and society.  Monumental shifts in human behavior no longer come from the inspiration of books written by John Steinbeck or Harriet Beecher Stowe, songs written by Bob Dylan or Woody Guthrie, or speeches given by Martin Luther King, Abraham Lincoln, or Mahatma Gandhi. While great leaders like these can still do great things, and evil leaders can still do evil things, both extremes are now possible through software in ways that these leaders never imagined.

Dramatic and rapid change in human behavior, both good and bad, now comes from a blog written by a common person followed by thousands or millions of common people... a picture of a dead immigrant infant washed upon the shore of Greece and posted on Instagram... a video of a policeman shooting an unarmed, non-threatening teenager posted on YouTube... the movement to overthrow a dictator, propelled by Twitter...  millions of secret documents about the National Security Agency or Panamanian law firm Mossack Fonseca, shared with millions of people with the click of a mouse to a web site... or relentless, anonymous taunts and bullying on Facebook that lead to a victim's suicide.

For those of us in the software business, we are obligated to apply our skills to the betterment of humanity, not to its detriment. This is especially true for those of us in healthcare software.  So far, the application of software to the betterment of patient care and the overall health of the communities, states, and country that we serve is despairingly low.

It's time for all of us who practice software in healthcare to radically up our game.

Nuclear and Healthcare Decision Making

Nuclear warfare operations was my data-driven decision making environment before the healthcare phase of my career. It was all about recogni...