The health care industry has never seen information technology (IT) as a way to improve patient outcomes. Instead, IT in healthcare has always been a back office affair where computers are used to schedule and to bill patients (and their payers).
Not to hold their medical records, much less disseminate those records to places where the records could do the patient the most good.
Computers also turned out to be pretty good at running clinical equipment like MRI machines, blood chemistry analyzers, etc. And those uses sparked the need for a certain level of interoperability among the various pieces of IT equipment but that interoperability tended, again, towards routine issues of administration.
Orders and demographics were sent out from the practice management systems. Results were sent back to them. Why? So that the procedures could be properly accounted and billed.
It was only after initiatives at the federal level, starting with the Health Insurance Portability and Accountability Act (HIPAA) and continuing through mandates such as the Health Information Technology for Economic and Clinical Health (HITECH) act and the FCC’s rural broadband initiative (which made possible the delivery of remote telehealth to the hinterlands).
Despite those initiatives, use of IT within the healthcare industry is still overwhelmingly administrative. To the degree that patient health records have been digitized is to the minimum degree required by things like HITECH’s Meaningful Use mandate.
To the degree that patient health records are interoperable is to the minimum degree required by law.
EHR vendors have nothing to gain economically by opening their systems to third parties and everything to lose should they lose control of the patient record. Never have so many feet been dragged by so few for so long.
This is bad. Really bad. Bad for individual patient outcomes. Bad for population health management.
Why? Because most of the promise of improving patient outcomes is associated with the meaningful use of electronic patient data. Data that is collected by, disseminated to, and analyzed by information technology existing outside the real confines of the institutions. Outside the hospitals. Outside the clinics.
Who is creating that information technology? It’s not the health care industry. It’s third-parties.
From Silicon Valley startups to the graduate schools of our nation’s universities — that is where the innovations that will drive improved patient outcomes are created.
But those innovations don’t work if they don’t have access to the data they need. Those innovations are patient-centric and patient-empowering, but the patient can’t use them if they can’t get at their (the patient’s) own health records.
Those innovations want to live as a service — software as a service (SaaS) — and they want to live “in the cloud.” It’s just so much easier, more practical, more available, and more reliable to leverage technology in the pursuit of better health care outcomes that way.
But if patient data isn’t freed from the clutches of the in-clinic, in-hospital, in-interoperable EHR systems then these third-party innovations just don’t work. If patient data isn’t “in the cloud” then none of these innovations can get at the data or contribute to the data.
They can’t add value.
They are dead in the water.
The United States leads the world in per-capita health care spending. To show for that we have the worst health care outcomes. But we also have a vibrant and willing entrepreneurial sector that can be a big part of changing that.