Beyond building a better mousetrap

 By John Lumpkin

I just purchased the new Kindle device.  I like to try new technologies with the understanding that they may not yet be perfected, but still I want to see for myself whether the new technology, however flawed it may still be, solves a problem.  In the case of the Kindle, for example, I tested it to see whether I could more easily read a book using the Kindle while on the exercise bike, instead of struggling to turn the pages of a fat paperback or hardcover book.

The answer, by the way, is "yes."  Score one for this particular technology.

This experimentation with the Kindle, however, raises the central question that should be asked of any new technological advance:  does it solve a problem?  And that central question should be asked consistently, and repeatedly, throughout all of the buzzing talk about health information technology (HIT) that's going on during the current health reform discussions.

The Robert Wood Johnson Foundation jointly sponsored, with the federal Office of the National Coordinator for Health Information Technology (ONCHIT), a research effort to track the adoption of health information technology--more specifically, the use of electronic medical records by physicians and other health care providers--for the past few years.  The findings from this effort have received a great deal of attention, mostly because the news about adoption is mixed, and people are wondering if the $19 billion allotted to health information technology in the recent stimulus legislation is enough.  And the question is, enough for what?  Will it solve the problems in health and health care?

I know why I and others yearn for HIT advances to improve health care--because health care has become such a fragmented, complex, costly, and sometimes frustrating enterprise, we yearn for technology to streamline and solve the problems.  Furthermore, the task demand of modern clinical practice routinely exceeds the bounds of human cognition (thanks to Dan Masys for that line).  It is almost unimaginable, in this day and age, to think of doctors and nurses spending time with mountains of paperwork, and of patients not having timely access to their latest test results, because we have failed to build interoperable, secure systems that allow those who give care, get care, and pay for care to exchange vital information.  And yet that is the reality we must face, and change.

Yet at the same time, we need to understand that HIT can only go so far to solve the underlying problems we face with our current methods of delivering and paying for health care.  For HIT to truly help solve some of these problems, people will need to change and adapt.  HIT may help people change and adapt, but it won't do it for them--it is a tool, to be applied only as much as people are willing to change and adapt.  In fact, all information technology does is speed up processes.  If you have poor process, HIT will only help you get to the wrong outcome more quickly.  Our challenge is to make the system better first, and use HIT to help facilitate people's efforts to improve care.

I leave you with Enrico Coiera's thoughtful contribution to the ACMI's discussion on this topic.  Apologies for the truncation, but I think this excerpt still captures his eloquent charge to the HIT thinkers--and reformers--of the world:

"In some ways, I think the current discussion is 'captured' not by the IT industry, but by 'IT thinking'--we are letting our contribution to the discourse be framed by what the IT industry says it can or cannot do.  We are not talking enough about what is out there 'beyond' the EHR.

Informaticians should understand that our first contribution is to see healthcare as a complex system, full of information flows and feedback loops, and we also should understand that our role is to help others 'see' the system, and re-conceive it in new ways.

I think the role of informaticians should also be to propose new information-enabled and system-wide interventions.  In other words, there are futures we can dream of, in which the health system looks very differently than it does today, and which can only be possible because of the way we harness information to measure and control.  The future should not be 'today plus the EHR.'  The future can be something completely different.....I think we need to be pushing the intellectual envelope of informatics, and we don't do that designing a better mouse trap, we do it by thinking the unthinkable.

At least, that's what I think it means to be an informatician!"

And for a recent physician's perspective on this issue, check out the cross-posted entry from Jay Parkinson here and here.