By Peggy Salvatore
The future ain’t what it used to be. – Yogi Berra
For those of you who follow my blog, you know that lately I’ve been searching for the edges of the promise of health information technology.
I used to think the fulfillment of HIT meant someday we’d all have access to complete health records, all in one place, available everywhere. The availability of the complete records would give us fabulous data sets that could be mined to determine which treatments worked in which people. By targeting the right treatments using a fully informed Clinical Decision Support system, we would get an outcome that would lower cost, increase quality and make it possible to treat a lot more people for the same (or fewer) dollars. Health technology also meant designer drugs – biologics that targeted diseases based on our genomic profile.
That was limited and faulty thinking on my part. I wasn’t thinking big enough. In the last five years, advances in health technology have far outpaced my ability to grasp its true promise. I am engaging in a study to determine where we are really going because I started to write a book and it led me down a few rabbit holes, so to speak. So far, I’ve encountered some ideas that I want to share with fellow health tech geeks.
Here are a few topline themes:
- We are building and paying for implementing a health information system in the U.S. that was designed in the 20th Century. Given the exponential rate of technological advance, that means that it was outdated before the first checks were cut to begin installation.
- We are building 3D body parts on printers. And it’s pretty cheap. And it can be done anywhere. In manufacturing, most of the money is in the spare parts. Ask any business person, if you had to build a car from the cost of individual spare parts it would cost a few hundred thousand dollars to build a Chevy. If you extrapolate that to healthcare, assuming the rules of the rest of the business world apply, then does that mean the real money in the future is in spare parts? Think way beyond hips and knees. Think kidneys and hearts and ears. Then keep thinking.
- One of my virtual colleagues, John Lynn, who guest blogged for me last week with his thoughts from HIMSS15, today posted a blog on the possibility of a genomic health record. I will link to that here so you can read it in its entirety. J. Craig Venter, the scientist who is credited with decoding the first of the human genomes at the turn of the 21st Century, tells us that there is no such thing as privacy of health information anymore. That is just a conceit we tell ourselves. Dr. Venter, who would know, told attendees of the Milken Institute Global Health Conference a few weeks ago that “they” can now reconstruct a complete picture of you from a fragment of your genetic material so each individual is personally identifiable. Period. You can’t put the toothpaste back in the tube on this. Our concerns about de-identification of patient data are upended.
- Now, let’s take items 2 and 3 together. If “they” can create a full picture of you from your DNA, does that mean that “they” can also reconstitute your body parts from that complete picture. So, you won’t be buying tires off the rack, to extend the Chevy spare parts analogy. You will be having spare parts designed directly from your DNA to perfectly match the part you’ve already got because it is…you got it…YOU! (Let me throw out this little bone: who owns your genetic information? Lawyers, get on your marks…)
A few weeks ago I wrote about the fact that news stories are telling us the first humans to live to be 500 are already born. If you can imagine that Craig Venter can recreate a perfect picture of you from a DNA swipe after he shakes your hand, then perhaps the market for spare parts is, indeed, where the money is in healthcare. Part by part, you can probably keep someone going for quite a while.
So Many Tentacles, So Little Time
This topic has so many tentacles that I will stop here so this article remains blog-length. My intention is just to put a little more information out there to expand our definition of health information technology.
Until recently, I was concerned that we were spending money installing electronic health information record systems that were not as comprehensive as they needed to be. I thought interconnectivity was lagging behind where it needed to be, and not sure that the incentives offered by the U.S. government were targeting the right things. Now, I am truly concerned that we are spending money building a system that is outdated before it’s installed. In fact, the more I research for this book, the more I am convinced of it.
Does that mean I advocate stopping the implementation of electronic patient record systems and just wait for things to shake out before spending any more money? No. Things are not going to slow down or stop so we can catch up. We just need to build systems that are flexible and responsive to support growth and change. We’re learning things in fits and starts by undertaking the process of getting electronic records online so it isn’t really sunk costs. It’s more like a loss leader. We aren’t going where people think we are going with this. I’m not sure where we will wind up, but I can pretty much guarantee it isn’t the destination we put in the health information technology GPS when we started out on this little adventure.
What are your instincts on where health information technology is going? Should we expand the definition to include the kinds of things I discuss here, like your genetic information? I would love to hear what you think. Please post a comment.