Informaticist manifesto

Our national experiment with implementation of electronic medical records has many implications[1]. Within the healthcare informatics community a broadly understood and appreciated goal of this effort is improved outcomes and reduction of healthcare cost. In large part, due to the HITECH Act, there is widespread attention being applied to implementation and installation of EMR systems. Looking ahead, we can anticipate an increasingly data rich environment in health care. Indeed some institutions such as Duke and the VA have already attained this status. But in order to move toward the goals of improved outcomes and economic efficiency, it is necessary to transform this wealth of data into insights about patient management, clinical decisions and workflows. This task presents multiple challenges.

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[1] PCAST report on healthcare IT, http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf

Pants emergency

After completing a hike in Snow Canyon Utah in the summer of 2010, I discovered that the keys to my rental car were stuck in the zippered pocket of my hiking pants. The zipper was jammed and no amount of tugging improved the situation. Attempts to tear open the zipper or pocket proved impossible. Making matters worse, there was no-one in the parking lot and I’d seen only a few hikers in the park. It was noon, about 100 degrees with no shade. Eventually I managed to poke the metal end of the key through the ripstop material of the pocket. I removed the shorts and was able to turn the key and start the car. I drove back to the hotel room in my underware with my pants dangling from the steering column like some bulky keychain. At the hotel parking lot, I put the pants back on, went to the room and got cleaned up. At the front desk after trying various tools, the keys were finally liberated by cutting the pocket open with a pair of scissors. Victory!

Coming market disruptions in health care

Last week I had the opportunity to listen to a panel discussion given by executives from Teradata and Claraview given at the Fuqua School of business. The primary purpose of the panel was to discuss career decisions and events made by the executives, intended as food for thought to the clinical informatics students in attendance. In the course of discussion and the ensuing Q&A, some interesting points were made by the panelist about implications of business trends in healthcare.

They made some familiar observations about the growing cost of healthcare, which is now at 16% of GDP, and how this is not sustainable, especially given the impact on medicare of the aging babyboomer population. They went further with this set of ideas than others I've heard, noting that pay-for-performance and other forms of capitation are likely the only ways to get costs under control. This will represent a complete sea change for the provider segment within healthcare, which now operates with a payment for procedure business model. They see this change bringing about an intense future need for investments in information systems on the part of providers in order to manage costs without loss of quality care. They noted that other industries such as manufacturing and retail, have gone through similar transformations and emerged as much more economically efficient markets through the application of data collection and analytics.