Tuesday, November 11, 2008

Magical Thinking in Implementing Healthcare IT

There was a great article published in the Health Affairs Journal by Carol Diamond from the Markle foundation - "Health Information technology: a few years of magical thinking" - abstract here the full text requires a subscription

The concept of magical thinking in this context was that implementers must resist the concept where this notion that
..isolated work on technology will transform our broken system...Another tempting and related notion suggests that a lack of technical standards is the main barrier to health IT adoption..
Given that as they state
...the literature on computerization, stretching back to the 1980s, is unambiguously clear on this point: computers are amplifiers. If you computerize an inefficient system, you will simply make it inefficient, faster. IT can contribute to improving care only when underlying system processes are transformed at the same time.
To be successful instead of joining the stampede of standard creations from the likes of Health Information Technology Standards Panel (HITSP) and the Certification Commission for Health Information Technology (CCHIT) which are increasing awareness in the public and helathcare industry but have not according to recent testimony by Sam Karp of the California HealthCare Foundation stated
"Not a single data element has been exchanged in real world health care systems using standards this process has developed or deployed."
The point being that standards are adopted and the process of standardization is incremental. The internet being a great case in point that was developed over severalyears and floated to users unfinished and lacking consistency to allow usr interaction and use to help refine and develop a standard that we all use on a daily basis

So taking this concept to the next level and looking at the 60% of healthcare notes that are simply free-form notes - providing simple easy access to essential parts of this information would be invaluable. And there lies the beauty of the of the CDA4CDT system allowign for the capture and sharing of this infomation wihtout the impostion of structure, coding or limitations of choices. Sections can be easily identified and shared in a meaningful way. At a high level in the first instance but in more detail as people explore and adopt this standard and actually use it. THis is a standard to use without the imposed and artifical limitations that normally accompany the typical narrow "ideal" standard that does not meet the test for real use and genuinely useful interoperability

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