Healthy Living A Fence On Gradual Versus Radical Change

Following is a give-and-take I'm having on a LinkedIn forum close adopting a real gradual approach to HIT development versus implementing a strategy promoting evolutionary leaps coming from disruptive conception as well as a focus on radical change.

Someone wrote: I own got proposed inward the past times as well as believe you lot powerfulness guide maintain that a meliorate approach would live on to do a model of information sets that could live on sent as well as received past times providers inward gild to "qualify" their systems. This does soundless require a information criterion but it allows the vendors to do their ain tools as well as for conception to thrive. Without a good defined information structure, we…will never live on inward a seat to leverage those innovative tools such every bit cognitive support.

And I replied: While I guide maintain that a model information laid would live on useful for qualification purposes, I've learned from sense that they tend to live on "minimum information sets" with minimal usefulness, instead of beingness comprehensive/complete multidisciplinary information sets that approach "maximum usefulness." The employment with such minimal information standards is that it sets the bar means also depression because vendors typically brand that minimum their ultimate goal, rather than developing tools that tin grip the maximum. I contend, therefore, that nosotros ought to evaluate HIT tools inward terms of (a) the depth as well as breadth of information they tin deal cost-effectively as well as (b) whether that information enables patients as well as clinicians to brand ever-better decisions past times providing patient-centered cognitive back upwardly (PCCS). That is how conception is sparked as well as meaningful alter is encouraged; anything less promotes a glut of me-too commodities with minimal usefulness.

He also wrote: So, start nosotros involve to telephone substitution information earlier nosotros tin own got activity on the data. In gild to telephone substitution the information nosotros involve a universally agreed upon information format. There are RHIOs as well as HIEs [i.e., organizations designed to enable information telephone substitution inward unopen networks of providers] inward house instantly that are functional but are non appropriate for a broader telephone substitution of information. For the most part, those early on implementations are proprietary systems that are scaled out to serve a region. While they own got provided a valuable service, they involve to arrange to a mutual information telephone substitution that tin live on used to portion information alongside other HIEs thus, a Nationwide Healthcare Information Network.

And I replied: Information telephone substitution is sure crucial. And I guide maintain that intra-RHIO/HIE information telephone substitution lonely is non enough; in that location must also live on inter-organizational information telephone substitution across RHIOs/HIEs. While information as well as technology standards offering a means to grip information telephone substitution challenges, they come upwardly with issues posing serious problems inward terms of cost, effort, time, hassle, complexity, inefficiency, usability, reliability, information loss, political influence, etc. One innovative depression terms solution we've been proposing is a publisher-subscriber node-to-node architecture with universal translation. I discussed these number ii years agone inward a serial of posts at this link.

He also wrote: Other than HIMSS wish to run across CCHIT every bit the certification body, I believe their proposal is sound. That alone brings us to the start step. I'm sure nosotros would all guide maintain that this volition live on an iterative process. ONC [The Health as well as Human Services' Office of the National Coordinator for Health Information Technology] needs to house a stake inward the Earth as well as so nosotros tin displace forward. Give us version 1 of a information object as well as nosotros tin start edifice Exchanges to acquire information to the EHR. Now nosotros tin start making usage (even meaningful use) of the information as well as piece of work toward improving healthcare. In fourth dimension hand us version 2 of the information criterion as well as nosotros volition ratchet upwardly functionality.

And I replied: Under the final administration—during the ONC NHIN initiative—$18.6 i G m was awarded to 4 large organizations, afterward deciding to renege on a promised 2/5 pocket-size occupation organisation set-aside despite receiving many applications from pocket-size businesses some the province (see this link). Those millions, inward the end, did non convey us whatever closer to an NHIN as well as left a real bad gustation inward the mouths of many innovative pocket-size businesses. Thus, it is of import to guide ONC inward guiding us past times assuring that innovative ideas from "weak voices" (i.e., individuals as well as pocket-size businesses) live on heard loudly as well as clearly, as well as live on influential!

He also wrote: We own got the data, nosotros exactly involve to improve the delivery as well as presentation of the information otherwise we'll live on buried nether information overload). We own got the knowledge; nosotros exactly involve management from the powers above. Give us clearly defined objectives as well as nosotros volition laid an Information System that volition live on forwards thinking as well as volition enable us to usage the patient's records every bit component of the handling process. Keep us inward the nighttime as well as nosotros volition become a hundred dissimilar directions, edifice dozens of perfectly functional systems that are each islands of information. One of the large failures of our healthcare scheme is non that nosotros don't own got the technology or the data; it's that nosotros don't own got the information where nosotros involve it when nosotros involve it.

And I replied: Yes nosotros own got data, but nosotros do NOT own got the information needed to do the necessary information as well as emerge the cognition required to realize substantially improvements inward aid effectiveness as well as efficiency. And this goes good beyond the information distribution challenge. But fifty-fifty if nosotros did own got the necessary data, information, as well as telephone substitution mechanisms, mainstream HIT tools would soundless NOT render adequate determination making assistance because they neglect to implement the patient-centered cognitive back upwardly process. Furthermore, I previously commented, in that location are serious problems with beingness overly reliant on restrictive standards on the "powers above."

So, nosotros ought non to live on squabbling close minimal information laid as well as the usage of conventional technology standards, but instead focusing our collective efforts on widespread collaboration to define the requirements for PCCS-enabled HIT that are able to deal comprehensive/complete multidisciplinary information sets with the potential to live on maximally usefulness inward both clinicians as well as patients/consumer inward their determination making. I much rather run across us going inward "hundred dissimilar directions" inward search of genuinely useful, disruptive HIT innovations, than to own got the powers that live on encourage adoption of the same onetime commodities that exactly cannot do the job.

Having said that, in that location is a house for today's EHR as well as CPOE commodities, i.e., to define the strengths as well as weaknesses of the "AS IS" HIT model, as well as so nosotros tin start edifice the "TO BE" model past times adopting the most advanced as well as promising HIT tools that tin overcome the AS IS model's deficits. These next-generation tools could live on add-ons to today's commodity products, or they may live on completely novel types of tools that volition supersede what's currently available.

He also wrote: I'm an optimist as well as believe that nosotros volition describe it all together. The timeline that we've been given nonetheless is non realistic. How many practices are going to live on inward a seat to satisfy the requirement that own got non yet been issued earlier Jan 2011? The bonus payment that takes the 2011 reimbursement to $18,000 is based on meaningful usage earlier Jan 2011.

And I replied: I fence that meaningful usage of next-generation HIT tin real good tumble out past times 2011 as well as without groovy expense! Success volition depend on the advertisement as well as adoption of radical (disruptive, discontinuous) innovation. [Full disclosure note: My fellowship is offering a novel cost-efficient means to telephone substitution as well as evolve computational models inward loosely coupled professional person as well as social networks, which is an essential role for developing as well as deploying PCCS-enabled HIT.]

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