Sunday, January 18, 2009

Who Can Solve Healthcare IT's Challenges? Part 1 - Google

In previous posts on the National Research Council report on HIT, the Joint Commission Sentinel Events Alert on HIT, and many others on HC Renewal I've alluded to my belief that a root cause of the state of healthcare information technology (high cost, low diffusion, poor usability, poor interoperability, low reliability, questionable benefits, lack of features most helpful to clinicians, etc.) is - to be frank - industry dysfunction.

Poorly led, mismanaged, conflicted, opportunistic, sometimes even unethical vendors, overly pushy marketing, less than stellar consultants, well-paid but of course "objective" clinical Key Opinion Leaders (KOL's) and spokespeople, and ossified strategy and tactics are examples of this dysfunction.

One merely needs to read statements such as came from the former head of the UK's CfH national program for Health IT to see how these issues can play out (I've seen them up close and personal, but I'm just a 'little guy' in HIT, so I shall defer to Mr. Granger on this).

This dysfunction takes the form of corporatization of HIT, creation of myths about its magic bullet capabilities in "revolutionizing healthcare" (I call this "bellicose grandiosity") and leadership by business IT professionals. The influence of the latter seems far out of proportion to their expertise in biomedical affairs.

I've written about the perils of the overarching assumption that supports this leadership model: that clinical IT is a subspecies of MIS (management information system), and that the methodologies and approaches for development, deployment and lifecycle of the latter are appropriate for the former.

In essence, true innovation is hampered by the current HIT ecosystem structure. See my HIT ecosystem essay here and another essay on the HIT industry by Dr. Jonathan Bertman here , the latter perhaps being taken with a grain of salt due to self-disclosed industry connections of its author. (Full disclosure: I have no financial stakes, stocks, or other tangible interests of any kind with any HIT vendor, consulting company, or any other concern related to HIT, and I take no consulting fees from them for any purpose whatsoever.)

How can the goals of innovation, alignment to user needs, quality, costs, accessibility, interoperability, context sensitive linkages to external science, etc., be met?

Or, perhaps the question really is, who - what organization(s) - can best provide those characteristics and features?

In "A Biomedical Informatics Manifesto" I addressed the domain expertise I feel is most needed.

I did not, however, address the "who" as in "what organization(s)." What organizations, that is, have the resources (e.g., financial and infrastructure) to make useful, usable, national, interoperational HIT happen? What organizations have the innovative track record to effectively engage the best specialists to make it happen?

One example comes to mind immediately. It was suggested by an expert in IT and bioinformatics I correspond with, Felix Fulmer.


These folks are innovative. Their services are reliable, fast (when is the last time Google was down or took a long time to provide query results?), widely available, cost effective (many services available for free!), and a true technological tour de force.

Billions of web pages are constantly crawled and indexed and content made available in a "world library computer" manner that just a few years ago would have been considered true science fiction. And the complexity of this process is hidden in a simple user interface, with excellent user interaction design. I'd studied and written about IR (information retrieval) issues just as the WWW was beginning, and what Google has created in those years is truly impressive.

They also offer their own ASP-model applications (here), have seemingly unlimited storage capabilities, and a true international presence. They get things done, and don't mess around or offer excuses for lack of performance.

They host millions of blogs at for instant editing and retrieval, anywhere, anytime, including this one.

They already have Google Health, a Personal Health Records service. (Addendum April 2009: some problems developed there due to apparent deviations from best IT practices, see this post).

Perhaps this organization exemplifies the kind of "can do" attitudes and accomplishments needed to solve decades-long disappointments in HIT.

The major HIT vendors certainly don't seem to be part of the solution. In certain cases of the more prominent ones such as Cerner, cook-the-books HBOC - now McKesson, TDS-AllTel-Eclipsys etc., I repeatedly hear exasperating stories about their products that confirm an impression I had after meeting some of the top HIT CEO's some years ago when I was a CMIO - that the CEO's and top lieutenants of these companies are , let's just say, not the sharpest pencils (one reason I have no financial stakes in these companies!)

Note: I also have no financial stakes, stocks, or other tangible interests in Google of any kind, nor receive any income from them, nor have I spoken to anyone at or associated with Google about the thoughts contained in this essay.

-- SS

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