Is there an ROI for Health IT? It depends.

One of the most frequently and hotly debated questions that I encounter in my professional life is whether health IT offers a measurable return on investment (ROI). Various studies and opinion pieces have addressed this question but no clear consensus has emerged. Maybe there is no single answer. Perhaps the answer is: “It depends.”

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Mike

The Applification of the EMR

Perhaps one of the Steve Jobs’ greatest legacies is the iPhone and the app ecosystem that it supports.   Rather than trying to define and develop every bit of functionality that an iPhone has to offer, Apple handed the opportunity to do so to hundreds of other organizations, large and small. Apple gave up some control in exchange for unprecedented growth in market share and, ultimately, stock price.  Imagine for a moment if a similar approach was applied to the design of EMRs and other eHealth applications.  Might the same level of innovation and user adoption result?   A team led by Harvard University seems to think so and was awarded $15M by the U.S. Office of the National Coordinator for Health IT to turn their ideas into reality.

You can read the rest of my monthly Technology for Doctors column here.

Mike

mHealth Rant

Check out my latest article in Technology for Doctors, an online publication for which I write a monthly column.  You can find it here.

I’d like to hear views on whether we need yet another buzzword.  I argue that mHealth will cause more confusion among potential users and divide the health IT community at a time when it should be united.

Mike

 

 

 

Should doctors be “forced” to use EMRs?

Tom Closson, the Ontario Hospital Association (OHA) President and CEO, created a bit of stir at the eHealth 2011 conference in Toronto when he suggested that doctors should face real consequences for not adopting electronic medical record systems such as not getting paid.   This same sentiment was expressed in a recent article in the Canadian Medical Association Journal.

Tim Wilson, a fellow Canadian eHealth blogger, explored Tom’s comments in a recent blog post.  I commented on this blog post with the following observation:

I agree that mandating EMR use is not the answer, at least not until we get more physicians using EMRs. While it might sound like the easiest path to take, forcing physicians to use an EMR casts them as technology resistors who simply aren’t smart enough to realize the benefits that EMR’s have to offer. Given their education and their use of some quite advanced technologies in other aspects of the practice of medicine, one has to wonder they aren’t pounding down the vendors’ doors to buy an EMR.

I suggested that it was perhaps a bit hypocritical of those who still use pen and paper for many daily work activities to admonish physicians for doing the same.

If we are unprepared to ditch pen and paper, what right do we have to ask physicians to do the same? Clearly there are usability issues still remaining with many EMR products and forcing physicians to use products that don’t fit how they work is not the answer. While I am not naive enough to suggest that usability is the only issue standing in the way of massive EMR adoption, I do believe it is a contributing factor.

What are your thoughts on this matter?  Head over to Tim’s blog and join the debate.

Mike

Steven Huesing Virtual Debates – First Debate

About a month ago I wrote a blog post about the The Steven Huesing Debates on Digitizing Canada’s Healthcare System. This virtual debate series is intended provide a platform to engage all stakeholders in open, unfettered discussions about the about the major issues impacting eHealth adoption and use, such as:

• Measuring the return on value to the patient
• Improving quality and safety
• Data sharing to respect the privacy rights of patients
• The appropriateness of the current agenda

The debates will be conducted virtually and will include a public commenting period. The first debate took place on 12 April 2011 and the public commenting period is now open. You can find information about the debate series as well as a recording and written synopsis of the first debate here.

I urge readers of this blog to participate in the virtual debate. Please check out the virtual debate website and offer your thoughts and comments. In particular, please offer your thoughts on the topics to be discussed In future debate sessions. The currently identified topics include:

• Patients as co-creators/owners: Should the HIT agenda change to build the infrastructure that ensures personal health information rests with the patient who shares it with others? Do you want patients to genuinely become a co-creators—to share power
• Aligning business models to incent using these systems: What changes in the current approach (business model and incentives) are necessary to speed up adoption and change processes of care to drive out more value?
• The need for e-health policy: The technology roll-out is advancing before we have e-health policies in place. What policies are needed to address challenges or potential barriers?
• Regulation vs. government edict: What would be the best approach to creating a carrot and/or stick regime to speed up adoption by clinicians?
• The right balance between top-down and bottom-up to drive the agenda: Is HIT in Canada emphasizing a more grassroots agenda driven by the patient and providers rather than a top-down approache driven by governments?
• Do we need a higher sense of urgency with the HIT agenda? If the answer is yes, then what do we do to build this into decision making and implementation?

What are your thoughts on these proposed topics? Are there additional topics that should be considered? Please go here to participate. Also, please let people in your own networks know about the debate series and encourage them to participate

Mike

The Steven Huesing Debates on Digitizing Canada’s Healthcare Systems

Late last year a small group of people decided that a mechanism was needed to engage more people in active discussion regarding the digitization of Canada’s healthcare system. Until now, very little real debate about the current healthcare IT agenda has occurred. Discussions to date have tended to focus on system manager needs and not so much on health outcomes. Most key stakeholders have had little say — providers, vendors, researchers and, most importantly, patients.

The Steven Huesing Debates on Digitizing Canada’s Healthcare System provide a platform to engage all stakeholders in open, unfettered discussions about the main unresolved issues, such as:

• Measuring the return on value to the patient
• Improving quality and safety
• Data sharing to respect the privacy rights of patients
• The appropriateness of the current agenda

The debates will be conducted virtually and will include a public commenting period.  The first debate will take place at noon eastern time on 12 April 2011 and will focus.  The debates and the commenting period that follows are open to anyone who wishes to add a comment. There is no cost for participation.  You can find more details here.  I encourage you to participate in what I hope will be a lively and informative debate series.

Mike

 

Infoway turns to the “crowd” for ideas

I first heard about this idea last fall and thought it was a great way to engage a wider audience in coming with new ideas for how to use IT to transform healthcare services delivery. Infoway’s ImagineNation ideas challenges offers cash prizes for “bold, new ideas – or creative combinations of existing ideas.”

Ideas will be evaluated according to four criteria:

1. Impact on Health and Health Care in Canada (30%)
2. Innovation & Originality (30%)
3. Effective Use of Technology (20%)
4. Feasibility (20%)

A total of $35,000 in prize money is available and will be awarded as follows:

• $100 for up to 50 top ideas
• $250 for the idea that receives the most votes from Canadians (“Canada’s Choice” Award)
• $5,000 for each of up to 5 top finalists
• An additional $5,000 for the winning idea

The top ideas will be announced July 5th just after the Canada Day long weekend.   You can find more details here.

According to Infoway, they plan to “promote the leading ideas” though the exact details of how they will do so have not been specified.  As well, they are “considering future initiatives that may be informed by the best ideas“.

Overall, I think that the notion of a public “challenge” is a good way to raise greater awareness of the impact that IT can have on healthcare and to more meaningfully engage Canadians in Infoway’s mission.   The US First Lady, Michelle Obama, issued a similar challenge last year to develop mobile applications to combat childhood obesity and not only raised awareness about this growing problem but also stimulated development of some innovative mobile applications.

I do wish that the public input would have a greater impact on selecting the winning ideas.  Perhaps a more substantial cash award could be associated with the “people’s choice”.  Or, maybe the criteria could be adjusted so that public voting would factor into the choice of the top winners.

Mike

 

 

Trouble in Canadian EMR market?

Since the start of the new year I have heard about significant management changes at a number of Canadian EMR vendors.  The most recent such change is the departure of Healthscreen’s CEO, Justin Belobaba. According to a media release dated March 4th, 2011, Mr. Belobaba has been replaced by Mr. Stewart Davis, Healthscreen’s Chief Operating Officer.

Although few details regarding the reasons for these management changes are publicly available, there are rumours that financial pressures and poor sales results are a contributing factors.  As the industry exhausts the early adopter and early mainstream physicians, are they encountering increased difficulties selling their solutions to the more skeptical and demanding late mainstream and laggard physicians?  Were provincial government forecasts for physician adoption of EMRs overly optimistic?

Mike

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NIST Publishes EHR Usability Guidelines

Regular readers of my blog and the articles that I write for several publications will know that I have considerable concerns about the usability of physician office health IT systems (typically referred to as EMR in Canada and EHR in the US). The US Office of the National Coordinator for Health IT (ONC) shares my concerns [or, perhaps, I share their concerns ] and has funded the US National Institute for Standards and Technology (NIST) to provide advice on how to improve the usability of EHR software.

According to a post on MedHealthWorld, NIST has released two publications related to EHR usability design and testing:

• NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records (NISTIR 7741) which offers advice on how to employ “user-centered-design” processes throughout an EHR product life cycle.
• Customized Common Industry Format Template for Electronic Health Record Usability Testing (NISTIR 7742) which provides a standard reporting format (known as the Common User Industry format) adopted and customized for testing EHR systems.

I am huge fan of user centered design. I have personally witnessed the level of user acceptance of the software produced using this approach. By actively engaging users throughout the design and development process, the likelihood of user acceptance is greatly increased. Indeed, I have seen users literally nagging developers as to when the software that they helped design would be ready for them to use.

Mike

The EMR/EHR Application Store

Mark and I have watched Apple and other mobile vendors create and support developer ecosystems with open APIs (application program interfaces) and application stores and have mused that a similar approach would be of considerable benefit in the health sector.  Well, it seems that Allscripts listened to us! Well, OK, they probably don’t know who we are but, watching the mobile application market, reached a similar conclusion.

According to information posted on the Allscripts web site, the Allscripts Developer Program (ADP) will “provide registered, approved members of our Allscripts Developer Program software development kits to enable clients and third parties to natively write applications on the Helios by Allscripts™ platform and integrate with other Allscripts applications.“  Helios is “an industry-defining open architecture platform that is designed to allow healthcare organizations to utilize best-of-breed applications in an integrated environment with Sunrise enterprise solutions.“

Rather than depend on its own R&D team to conceive and develop every possible application that their clients might need, Allscripts will leverage the resources (both financial and human) of its partners to accelerate innovation and better serve its clients.  Mark and I believe that a similar approach could accelerate “meaningful use” of EMRs by Canadian physicians by encouraging the development of new and interesting applications that make creative use of data stored in an EMR.

Mike