Network-Centric Warfare and Health IT

After my laptop gave out on a long flight to San Diego last week, I caught up on some reading. Wired offered an intriguing article about the failure of network-centric warfare in Iraq. The article described the basic concepts underlying the Pentagon’s approach of network-centric warfare.

The central idea is that an IT-enabled, highly networked force, that can communicate instantly in a peer-to-peer fashion can have the information it needs, when it needs it, to make rapid decisions. Such a force – that can pinpoint targets with breathtaking accuracy and eliminate them with air strikes within minutes – could overwhelm much larger, less technologically advanced forces. The article provided examples: small Special Forces teams defeating Iraqi Army units outnumbering them by as much as 500:1, a decrease in the time from target identification to target elimination from 3 days in the first Gulf War to under 10 minutes in the current conflict.

But then it goes on to discuss how this strategy, while highly effective in overrunning Saddam’s army, was entirely inappropriate for the years of fighting the insurgency that followed. The fascinating insight from the article was that the network-centric strategy failed because it excluded the most important nodes, or sources of information, from the network: many of the US troops on the ground, local policemen, Iraqi army officers, and tribal leaders. The counter-insurgency strategy that has apparently had some success in Iraq involves much more of a low-tech, messy, patient, trust-building social network approach.

So now let’s consider health IT, where we hear discussions of a nationwide interoperable network of electronic health records that could give clinicians the information they need, when they need it, to make the right clinical decisions.

In the same way that network-centric warfare is remarkably good at killing the enemy (as opposed to persuading the enemy not to be an enemy), network-centric health care (as so often envisioned) might be remarkably good at caring for acute conditions, where relatively little independent patient compliance is required (e.g., show up for surgery, adhere to a short course of medications), but for the messy world of chronic disease – perhaps not so much. In the same sense that in Iraq the network didn’t benefit from its most important participants, one could argue that network-centric healthcare, by not more deeply engaging the patient, fails in the same sense.

Which brings me to the meeting to which I flew. The Markle Foundation convened about 100 people to talk about key health IT issues (see David Kibbe’s post at the Health 2.0 blog for an insightful report on the meeting). At the meeting, Jamie Heywood gave a presentation of his site, PatientsLikeMe, which pulls together data from patients with ALS, Parkinson’s, MS, and HIV/AIDS. They’re getting extensive self-reported data about how each disease is progressing in different people, the symptoms they’re experiencing, the medications and treatments that people are taking, and the effects that they’re having.

Their numbers have grown to the point that they have more participants than most clinical trials on any of these diseases and they offer patients a very different body of information about their disease than what they’ll find in the literature. It’s the street intelligence: the day-to-day understanding of what’s really going on at the ground level in the war (in this case) against certain chronic diseases.

So to me, the parallel is striking: just as it is now with some hindsight that one can understand the flaws of the network-centric warfare strategy in Iraq, it would seem that a network-centric health system needs to move sooner rather than later to figure out how to incorporate the vital information assets that each person brings to the network.

Comments

[Vince Kuraitis]

Steve, Thanks for a very thought provoking post. I think the analogy to network centric warfare does have lessons for health care.

Yes, I agree that network analogy probably points to the relatively application in acute care settings geared for quick, decisive, potentially life saving interventions.

But I'm not sure that I draw the same implications about potential lack of effectiveness of the "network" for chronic care. The lesson here might be the need to build a broad network and to make sure that we include the right nodes of information, e.g., lab tests, multiple types of patient information (remote monitoring data, HRAs, health status measures, etc.), pharma data....beyond the obvious clinical measures that are obviously useful in an acute care setting.

[Steve Downs]

Vince -- thanks for your comment. I think we're actually in complete agreement. I don't mean to suggest we throw the baby out with the bath water -- a network approach is critical to chronic care as well. Instead, I think we should make sure that, as you say, the network includes all the right nodes of information and that we especially make sure to take advantage of the information that's offered by the patient herself and those who help her out on a day-to-day basis. At our most recent Project HealthDesign workshop, Roger Luckmann and his team from UMass Medical School presented their vision for a set of tools top help people manage their chronic pain. They focused on the questions that a user might have and, as an example, sought to answer the question "why do I have good days and bad days?" Hypothetical answers included insights that the user's pain tended to correlate with lower outdoor temperatures and bad days often followed days of intense exercise. These insights won’t likely come from the standard sources of information in the health care system, but rather from the full particpation from the patient herself in the network.

[Maria]

I this is the first time I log into this website but I am interested in this discussion. I provide medical services to children and adolescents with a chronic illness. What would be the role of age and personal medical records that would be kept BY adolescents? These folks are certainly more familiar with the internet, technology and videogames.

[Susan Promislo]

Maria,

Thanks for visiting and posting a comment. There are a couple of projects supported by Project HealthDesign, a national program that is designing next-generation PHR systems, that you may be interested in checking out. A team at Vanderbilt University is developing a PHR application that will help kids with cystic fybrosis, and their extended care network, manage their disease. And, a team at the Art Center College of Design is building a transmedia PHR tool to help adolescents with chronic illnesses transition to the adult care system. That team is very much geared toward designing PHR applications that build off the media and info. preferences of the cell phone/iPod/Facebook generation.

You can learn more at http://www.projecthealthdesign.org/projects ... Project HealthDesign also runs its own blog at http://projecthealthdesign.typepad.com/.