Comments on: Bill Stead on the National Research Council’s Report http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/ Healthcare IT News and Opinion Fri, 12 Mar 2010 21:24:30 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Ignacio Valdes http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/comment-page-1/#comment-3661 Ignacio Valdes Wed, 11 Mar 2009 16:31:41 +0000 http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/#comment-3661 I agree with your conclusions. There is far more at stake than what you state which I've discussed here: http://linuxmednews.com/1236661936/index_html The thing missing is a mechanism for the flexibility you describe. The government appears poised to double down on allowing federal funds to pay for proprietary EMR black box software, greatly reducing the needed flexibility and field serviceability that you describe. It is a throwback to alchemy in which techniques were kept secret for turning lead into gold in order to corner the market. The side effect was that everyone had to discover on their own that mercury is poisonous. I have called for a law allowing federal purchasing funds to only be used for Affero General Public Licensed software. So far I am meeting much resistance but it is the only way that such flexibility and performance can be assured. -- IV I agree with your conclusions. There is far more at stake than what you state which I’ve discussed here: http://linuxmednews.com/1236661936/index_html The thing missing is a mechanism for the flexibility you describe. The government appears poised to double down on allowing federal funds to pay for proprietary EMR black box software, greatly reducing the needed flexibility and field serviceability that you describe. It is a throwback to alchemy in which techniques were kept secret for turning lead into gold in order to corner the market. The side effect was that everyone had to discover on their own that mercury is poisonous. I have called for a law allowing federal purchasing funds to only be used for Affero General Public Licensed software. So far I am meeting much resistance but it is the only way that such flexibility and performance can be assured. — IV

]]> By: Just Silly http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/comment-page-1/#comment-3042 Just Silly Wed, 14 Jan 2009 06:12:52 +0000 http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/#comment-3042 Bill is just rationalizing his history. 10 years to implement? Maybe at Vandy, if you try to build it on your own from scratch. Not in most of the rest of the free world though. Bash vendors all you want Bill, but don't project your failures on an entire industry. Bill is just rationalizing his history. 10 years to implement? Maybe at Vandy, if you try to build it on your own from scratch. Not in most of the rest of the free world though. Bash vendors all you want Bill, but don’t project your failures on an entire industry.

]]> By: John Haughton MD, MS http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/comment-page-1/#comment-3032 John Haughton MD, MS Tue, 13 Jan 2009 03:54:53 +0000 http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/#comment-3032 Great report. Looks as if it might explain alot - for example, have physicians been reluctant purchasers or Saavy consumers - Looks like Physicians are Saavy consumers holding on buying expensive EMR systems with little proof of efficacy. Simple programs, designed to improve care work. It's possible to spend less than $100 / month / physician and improve metrics of care from 40% to 80% within a three or four month period. The secret is the right information in the point of care workflow; performance monitoring and safety-net lists of patients falling through the cracks - in other words, communication and knowledge within workflow - whether a paper or electornic office. Congrats to the NRC team for a terrific report highlighting the emperor's clothes in the HIT world. Hopefully application of the economic stimulus funds from the federal government will follow the path illuminated by the NRC report. John Haughton MD, MS DocSite Great report.

Looks as if it might explain alot – for example, have physicians been reluctant purchasers or Saavy consumers – Looks like Physicians are Saavy consumers holding on buying expensive EMR systems with little proof of efficacy.

Simple programs, designed to improve care work. It’s possible to spend less than $100 / month / physician and improve metrics of care from 40% to 80% within a three or four month period.

The secret is the right information in the point of care workflow; performance monitoring and safety-net lists of patients falling through the cracks – in other words, communication and knowledge within workflow – whether a paper or electornic office.

Congrats to the NRC team for a terrific report highlighting the emperor’s clothes in the HIT world. Hopefully application of the economic stimulus funds from the federal government will follow the path illuminated by the NRC report.

John Haughton MD, MS
DocSite

]]> By: Frank POggio http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/comment-page-1/#comment-3030 Frank POggio Mon, 12 Jan 2009 22:36:04 +0000 http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/#comment-3030 I am not surprised to see the results of the IOM study. I could not agree with them more. I have been in the health care IT profession for over thirty years and although progress has been made over those years, IT in healthcare is still viewed as a transaction /data system, not an intelligent system to support clinical or administrative workflow. For forty years we have invested billions of dollars in capturing, storing, aggregating and reporting transactional data. We, as an industry are data rich, and information poor. So why is it that way? Why don't we have more ‘smart’ process oriented tools /systems instead of an oceans of data on incomprehensible reports? Here’s my assessment: 1) It is significantly less for a for a vendor to build data transaction systems, than process support systems. They could burn through billions of dollars building a real process oriented system and never see a ROI. 2) Building data systems that can support and improve clinical or administrative processes is very complex and very time consuming. 3) Process systems and clinical protocols can vary significantly from facility to facility. Whether that is good or bad is separate debate, but that is the way it is still today. 4) Clinical protocols are dynamic, medicine is not a stagnant science, and what we don't know can fill the universe. We learn something new every day, and we adapt it by changing the protocol. So an automated process system would have to change with it ­ ...over and over. Some of these same challenges exist outside of healthcare in other industries. Many sophisticated tools have been developed to address process variability. We should look at applying as many as we can. It’s time we started doing something with all that ‘data’. Frank Poggio President The Kelzon Group Barrington, IL I am not surprised to see the results of the IOM study. I could not agree with them more.
I have been in the health care IT profession for over thirty years and although progress has been made over those years, IT in healthcare is still viewed as a transaction /data system, not an intelligent system to support clinical or administrative workflow. For forty years we have invested billions of dollars in capturing, storing, aggregating and reporting transactional data. We, as an industry are data rich, and information poor.

So why is it that way? Why don’t we have more ‘smart’ process oriented tools /systems instead of an oceans of data on incomprehensible reports? Here’s my assessment:

1) It is significantly less for a for a vendor to build data transaction systems, than process support systems. They could burn through billions of dollars building a real process oriented system and never see a ROI.
2) Building data systems that can support and improve clinical or administrative processes is very complex and very time consuming.
3) Process systems and clinical protocols can vary significantly from facility to facility. Whether that is good or bad is separate debate, but that is the way it is still today.
4) Clinical protocols are dynamic, medicine is not a stagnant science, and what we don’t know can fill the universe. We learn something new every day, and we adapt it by changing the protocol. So an automated process system would have to change with it ­ …over and over.

Some of these same challenges exist outside of healthcare in other industries. Many sophisticated tools have been developed to address process variability. We should look at applying as many as we can. It’s time we started doing something with all that ‘data’.

Frank Poggio
President
The Kelzon Group
Barrington, IL

]]> By: robert galin http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/comment-page-1/#comment-3026 robert galin Mon, 12 Jan 2009 18:33:45 +0000 http://histalk2.com/2009/01/12/bill-stead-on-the-national-research-councils-report/#comment-3026 I suggest the committee take a close look at the NHS in the UK, and the minimal success achieved there. There is much to learn from their experience. I suggest the committee take a close look at the NHS in the UK, and the minimal success achieved there. There is much to learn from their experience.

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