Monday, June 18, 2012

Mandl and Kohane offer an escape from the EHR trap

I had barely published the post below about opening up electronic medical record systems to innovative applications when a friend forwarded this article by Kenneth Mandl and Zak Kohane in the New England Journal of Medicine.  It is like the Gettysburg Address from two of the world's experts, a powerhouse contained in just a few paragraphs.


It is a widely accepted myth that medicine requires complex, highly specialized information-technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life.

We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functionality needn't reside within single EHR systems, and there's a clear path toward better, safer, cheaper, and nimbler tools for managing health care's complex tasks.

Loss of technological leadership reflects apathy and even opposition by EHR vendors to promoting liquidity of the data they collect. This attitude has thwarted medicine's decades-long quest for an electronic information infrastructure capable of providing a dynamic and longitudinal view of the health care of individuals and populations. EHR companies have followed a business model whereby they control all data, rather than liberating the data for use in innovative applications in clinical care.

Health IT vendors should adapt modern technologies wherever possible. Clinicians choosing products in order to participate in the Medicare and Medicaid EHR Incentive Programs should not be held hostage to EHRs that reduce their efficiency and strangle innovation. New companies will offer bundled, best-of-breed, interoperable, substitutable technologies . . . that can be optimized for use in health care improvement. Properly nurtured, these products will rapidly reach the market, effectively addressing the goals of “meaningful use,” signaling the post-EHR era, and returning to the innovative spirit of EHR pioneers.


Victor Cook said...

Amen. We changed direction this year to put emphasis on interoperable, substitutable technology. We have cut costs and improved performance. Best of all, we feel more empowered. At the end of the day, we are the system and the goal is to deliver health, not computers are the system and the goal is to deliver records.

Anonymous said...


Please share with readers how/where you found the interoperable, substitutable technology solutions!

As I talk with more and more IT savvy people in the Games for Health sector, they are amazed at the un-user-friendliness of current Health IT solutions.

The world is moving toward open source solutions that unite versus isolate. Meaningful Use deadlines put pressure to settle for solutions that are limited unless leaders step in and demand IT solutions for their healthcare businesses that not only address the needs of provider and patient, but are sustainable and will be around 10 years from now. Is that asking too much?