The Medical Matrix has you

I just read the following article from the Harvard Business Review. The name of the piece is: “Speeding Up the Digitization of American Health Care”. To be blunt, the article does not introduce any new ideas nor provide new insights into this whole issue. The article lists the positives and negatives of electronic medical care, topics that have been exhaustively discussed before, and then finishes off with a reference to the financial, i.e. nonmedical, issues that are blocking the full implementation of a universal electronic health record system that can communicate with everyone, and use tools like AI to improve medical care.

What caught my eye was the explicit statement that despite 10’s of billions of dollars of investment, it is still only 50% of private practices that have computerized themselves. The situation across hospitals is better, but this still rests at 76%, i.e. 1 in 4 hospitals are not computerized. To be fair, this might be a snapshot along a progressive curve up to 100% for both hospitals and private offices. Time will tell.

A very important other explicit statement is made in this article, that despite being known, is still spelled out so clearly that there can be no misunderstanding of the truth.

Patients tend to be loyal to doctors and hospitals at least in part because that’s where they’re known – that’s where their records reside. If that information can travel to another hospital or doctor at the push of a button, patients can more easily leave current providers behind. That’s not good for business.

Am I truly the only one who sees this as a version of kidnapping? I am by no means a lawyer, but if I hold onto an object or document that is critical to you, and thereby force you to behave in a certain manner that may very well be counter to your well-being, that sounds like a crime.

I will state for the umpteenth time that I am a socialist. On the other hand, I am fully aware of the fact that someone has to pay the bills. I do not deny these digital health companies the right to make a profit. But it strikes me that they should be making that profit by providing top-quality products that Healthcare Services want to purchase.

When Microsoft was challenged as to their forced inclusion of Internet Explorer into Windows, this was deemed as an unfair business practice. As it turns out, Internet Explorer imploded and lost major market share to alternatives such as Firefox and Chrome. But this entire issue of enforcing the use of a specific piece of software was enough to get the entire EU into a tizzy. Coercing patients into using a specific health record system is far more diabolical, far more dangerous to the patient, and just fundamentally far more unethical. And yet, there is no cry out from the general masses. Perhaps people are so used to being treated as passive guinea pigs within the health care system, that such an abuse of their freedom is totally overlooked.

The best possible answer to the present situation is for a separate company, whether a startup or well-established, to write an entirely new electronic health record system, along with a whole set of digital aids for medical care. This package of services would need to be clearly superior in every way to existing systems. One should take into account that large-scale implementations of present day EMRs, like EPIC, can cost well over a billion dollars. Once such an implementation has been made, no one turns around and says “throw it out, and let’s try something completely new”. So I am aware of how hard it would be to get hospitals and health care services to switch away from their present systems.

On the other hand, progress waits for no one. Just as the founding members of Skype single-handedly reshaped the entire telecommunications industry, it is possible  that some group, somewhere is working on a set of services that will do the exact same thing that Skype did, except this time it will be to the medical world.

I am well known for the phrase “if I had a billion dollars just sitting in my pocket, I would …”. In this particular case, I would be more than happy to invest this money in an open source environment that incorporated the best possible design, totally geared towards the type of clinical work that is done on a regular basis in healthcare institutions. From my own experience, it is very possible to create a new interface from scratch that is well accepted by the physician users. It would be critical to have the input of physicians and nurses and other healthcare workers in the design of such a system. On the other hand, I will always remember the quote by Steve Jobs that people don’t know what they want until you show it to them. So a balance would have to be struck between “expert opinion” and personal vision as to the ideal system.

Each department would need a custom designed interface that focuses on the information that is critical to them. It is somewhat ridiculous to require a pediatric department to fill in all of the information related to risk for heart disease [although there are cases where this must be considered]. The oncology departments would need a fundamentally different interface that the orthopedic department. And clinical assistant tools, i.e. specialized software modules that help the physician in any task necessary, would have to be customized as well to the specific needs  of a department.

Every hospital is different and every hospital has different protocols. And decisions would have to be made how these protocols are enforced. But a mechanism would need to be found – otherwise the universality of the system would be limited.

Once all of the pieces come together, sharing information should be relatively easy to manage. Making such a system open source would give hospital IT departments the opportunity to test the system without any commitment.

How would such a company make money? One could sell consulting services, and planning services (especially for major installations) and one could charge for add-ons (such as AI based diagnostic tools). I am by no means a business person, but I still believe that such a project is viable.

I know that we are not living in the Garden of Eden, and that such a project, no matter how well-funded, would come up against great difficulties and may ultimately fail. But the present situation where patients are held at gunpoint, so that they dare not stray to another service, is unconscionable. Someone with sufficient authority needs to firstly call out this practice as illegal and then require the complete elimination of such practices as soon as possible.

I am aware of projects that are presently being undertaken to help in the sharing of data, especially amongst the major EMR companies. But this is patchwork. Even though this connecting software may work well, all it takes is for one EMR company to change something in their internal design, and the connecting software will have to be redesigned. This is not the proper solution.

This article in the Harvard business review deserves to be hailed as a whistleblower as to the unethical practices of the major EMR companies. The time has come for those in charge, to jump on this fact and set things straight.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.