A Scrap On Gradual Versus Radical Change
Following is a give-and-take I'm having on a LinkedIn forum nearly adopting a real gradual approach to HIT development versus implementing a strategy promoting evolutionary leaps coming from disruptive excogitation as well as a focus on radical change.
Someone wrote: I conduct maintain proposed inwards the past times as well as believe you lot mightiness concur that a meliorate approach would last to do a model of information sets that could last sent as well as received past times providers inwards society 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 excogitation to thrive. Without a good defined information structure, we…will never last inwards a seat to leverage those innovative tools such every bit cognitive support.
And I replied: While I concur that a model information laid would last useful for qualification purposes, I've learned from sense that they tend to last "minimum information sets" amongst minimal usefulness, instead of existence comprehensive/complete multidisciplinary information sets that approach "maximum usefulness." The occupation amongst such minimal information standards is that it sets the bar means besides depression because vendors typically brand that minimum their ultimate goal, rather than developing tools that tin ship away grip the maximum. I contend, therefore, that nosotros ought to evaluate HIT tools inwards damage of (a) the depth as well as breadth of information they tin ship away handle 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 upwards (PCCS). That is how excogitation is sparked as well as meaningful alter is encouraged; anything less promotes a glut of me-too commodities amongst minimal usefulness.
He also wrote: So, get-go nosotros bespeak to telephone substitution information earlier nosotros tin ship away accept activity on the data. In society to telephone substitution the information nosotros bespeak a universally agreed upon information format. There are RHIOs as well as HIEs [i.e., organizations designed to enable information telephone substitution inwards shut networks of providers] inwards house forthwith 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 conduct maintain provided a valuable service, they bespeak to accommodate to a mutual information telephone substitution that tin ship away last used to portion information amid other HIEs thus, a Nationwide Healthcare Information Network.
And I replied: Information telephone substitution is sure crucial. And I concur that intra-RHIO/HIE information telephone substitution solitary is non enough; at that spot must also last 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 upwards amongst issues posing serious problems inwards damage of cost, effort, time, hassle, complexity, inefficiency, usability, reliability, information loss, political influence, etc. One innovative depression toll solution we've been proposing is a publisher-subscriber node-to-node architecture amongst universal translation. I discussed these number ii years agone inwards a serial of posts at this link.
He also wrote: Other than HIMSS wish to come across CCHIT every bit the certification body, I believe their proposal is sound. That exclusively brings us to the get-go step. I'm sure nosotros would all concur that this volition last 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 inwards the Earth as well as then nosotros tin ship away displace forward. Give us version 1 of a information object as well as nosotros tin ship away start edifice Exchanges to acquire information to the EHR. Now nosotros tin ship away start making utilization (even meaningful use) of the information as well as piece of work toward improving healthcare. In fourth dimension give us version 2 of the information criterion as well as nosotros volition ratchet upwards functionality.
And I replied: Under the concluding administration—during the ONC NHIN initiative—$18.6 1 one 1000 thousand was awarded to 4 large organizations, later deciding to renege on a promised 2/5 minor occupation organisation set-aside despite receiving many applications from minor businesses around the province (see this link). Those millions, inwards the end, did non convey us whatever closer to an NHIN as well as left a real bad sense of savor inwards the mouths of many innovative minor businesses. Thus, it is of import to guide ONC inwards guiding us past times assuring that innovative ideas from "weak voices" (i.e., individuals as well as minor businesses) last heard loudly as well as clearly, as well as last influential!
He also wrote: We conduct maintain the data, nosotros exactly bespeak to improve the delivery as well as presentation of the information otherwise we'll last buried nether information overload). We conduct maintain the knowledge; nosotros exactly bespeak management from the powers above. Give us clearly defined objectives as well as nosotros volition laid upwards an Information System that volition last forrad thinking as well as volition enable us to utilization the patient's records every bit portion of the handling process. Keep us inwards 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 conduct maintain the technology or the data; it's that nosotros don't conduct maintain the information where nosotros bespeak it when nosotros bespeak it.
And I replied: Yes nosotros conduct maintain data, but nosotros do NOT conduct maintain the information needed to do the necessary information as well as emerge the noesis required to realize substantially improvements inwards attention effectiveness as well as efficiency. And this goes good beyond the information distribution challenge. But fifty-fifty if nosotros did conduct maintain 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 upwards process. Furthermore, I previously commented, at that spot are serious problems amongst existence overly reliant on restrictive standards on the "powers above."
So, nosotros ought non to last squabbling nearly minimal information laid as well as the utilization 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 handle comprehensive/complete multidisciplinary information sets amongst the potential to last maximally usefulness inwards both clinicians as well as patients/consumer inwards their determination making. I much rather come across us going inwards "hundred dissimilar directions" inwards search of genuinely useful, disruptive HIT innovations, than to conduct maintain the powers that last encourage adoption of the same one-time commodities that only cannot do the job.
Having said that, at that spot 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 then nosotros tin ship away start edifice the "TO BE" model past times adopting the most advanced as well as promising HIT tools that tin ship away overcome the AS IS model's deficits. These next-generation tools could last add-ons to today's commodity products, or they may last completely novel types of tools that volition supervene upon 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 even as well as then is non realistic. How many practices are going to last inwards a seat to satisfy the requirement that conduct maintain non yet been issued earlier Jan 2011? The bonus payment that takes the 2011 reimbursement to $18,000 is based on meaningful utilization earlier Jan 2011.
And I replied: I debate that meaningful utilization of next-generation HIT tin ship away real good hap past times 2011 as well as without keen expense! Success volition depend on the advertisement as well as adoption of radical (disruptive, discontinuous) innovation. [Full disclosure note: My society is offering a novel cost-efficient means to telephone substitution as well as evolve computational models inwards loosely coupled professional person as well as social networks, which is an essential business office for developing as well as deploying PCCS-enabled HIT.]