fbpx
 +1 386-243-9402 MON – FRI : 09:00 AM – 05:00 PM

DoctorsLast week’s story about healthcare got some reactions. At a high level there is both concern for privacy and on the other hand hope that paperwork, healthcare costs, and medical errors can be reduced. It is no slam-dunk for sure, especially in the short run. Most people agree that electronic medical records are a key element in the overall solution. There are many potential benefits including not having to fill out a clipboard of paperwork every time you go to a healthcare provider and not having to get repeat blood work or imaging because the doctor can’t get access to the data from tests you recently had. EMR’s also have the potential to increase collaboration among doctors and other providers resulting in better outcomes. Longer term, the electronic medical records can lead to "information based medicine" which has the potential to base prescriptive care on the specifics of each patient combined with a large database of what worked and did not work for people who have the same condition. Ultimately we will have medications based on a DNA analysis of the an individual patient. There is much to hope for in an electronic world.
Larry Medina in Danville, California is more than skeptical. Medina, who has spent decades working with information related technologies, is concerned about EMR implementations — especially if managed by a large tops down government program. (See his story called Are you ready to risk YOUR LIFE on “Electronic Medical Records”?). I agree with many if not most of Larry’s points. Big projects are always risk prone. Larry points out a good example of this at Kaiser Permanente (See Problems abound for Kaiser e-health records management system where an internal report details hundreds of technical issues and outages). If there is one thing I have learned over past forty years it is that the best projects are the small ones. My motto is "think big, act bold, start simple, iterate fast".
The role of government in healthcare is important — not to implement big ideas but rather to foster the creation of standards among IT companies, healthcare providers, and the payers (insurance companies). It is really critical to our health that all the "players" can interchange data. Larry has expressed valid concerns about security, privacy, systems reliability, and project management. The question becomes what to do. Some would say don’t do anything until you can be sure you can do everything and do it right. To me that means we never get to the starting line let along the goal line. A better approach is to start simple, build pilots, try something with a small number of patients in one department, extend it to a second department, connect with the payers, add some more patients, and another clinical area, etc.
The best proof point of start simple, iterate fast is the Internet itself. The Net is a global network operating in nearly every country on Earth and connecting millions of computers and a billion people. It did not start that way. I can remember when email was about all you could do and only between a handful of universities and government labs. The Net did not get to what it is in big steps. It was continuous evolution through a huge number of baby steps. In my opinion, the same approach needs to be taken in healthcare. I agree with Larry. We don’t need big steps. We need a lot of little steps and we need them urgently.