Viva La Revolution

I just read a fascinating blog post from Chris Seper. In this post, Mr. Seper suggests that IBM purchase Validic and Athenahealth. I agree wholeheartedly that such a purchase would be a game changer in the health arena, and I will explain why.

First, let me take a moment to explain the focus of the companies I’ve mentioned. Validic does something conceptually simple yet technically very difficult, and thus critically important for many other companies. Validic imports data from a whole range of health data generators and presents all of this data  in a unified format. If you are designing health software that needs access to someone’s various wearable data sources, Validic can make this far easier. Athenahealth is a medical services company which is well-known for its web based electronic health record (EHR) system. Because of its web focus, the Athenahealth EMR is much more mobile, easier to maintain and update. These days also, you can do beautiful interface design using web-based tools. Finally, IBM is the creator and owner of its famous Watson system, that can mimic human learning and apply it to vast amounts of free form information and formal documents (such as medical research papers).

Imagine now that you combine the following abilities: (1) collecting all personal medical information, regardless of the source, (2) a web-based system for providing all EHR needs and (3) a data analysis system that can process massive amounts of medical data and extract critical conclusions that can affect population level care as well as individual care. To me, this sounds exactly like the promised future of digitizing health information.

I remember having conversations when I was first  studying computer science, about the potential benefits in healthcare. I was doing a double degree in physiology and computer science, so it was natural for me to have this kind of conversation. Moreover, as I was planning to apply to medical school at the time, I was trying to look forward and think about how computers could eventually be a benefit to physicians.

I add the following just for a cute piece of personal history. I managed to find a crossover project related to physiology research and software development. For those who remember, the software part of the project was written using DEC assembler on a computer called a PDP-11 73. Just to give you a sense of what kind of computer this was, it was (at the time) top-of-the-line for an independent lab [in which I was working]. This computer had 64K (not gig) of memory, and a hard disk with a whopping 5 MB of storage. But, it worked like a dream and made it possible for me to complete my senior thesis in both computer science and physiology.

There has been a tremendous amount of negative feedback about today’s computer offerings in the medical arena. With the major uptake in computerization of medical services in the United States, due to Obama care, many doctors and hospitals have been forced to purchase and use an EHR. In many cases, this was the first time that many physicians were using a medium other than pen and paper. It is actually astounding how many medical services were not computerized, until recently.

Change is always hard. And doctors are particularly wary of change for many reasons. Force a doctor to use a system that he or she was not trained on, and there will be resistance. Force every doctor in the United States to use systems that they had never heard of until a few years ago, and the resistance is very significant. Threaten the doctors that failure to use these computerized systems will result in fines and other “punishments”, and you have nothing short of a rebellion of their souls.

Although the computerization options that were available to the doctors had actually been around for some time, the focus of these digital EHRs was not on the clinical management of patients. For example, doctors found themselves having to deal with data entry that had nothing to do with the outcome of the patient’s care. And, needless to say, doctors had zero patients for bugs, outages and anything that would interfere with their work. Many doctors found that working with these EHRs slowed them down dramatically. When a doctor works slower, patients wait longer, get poorer care, and the doctor gets paid less. This is hardly the formula for a successful revolution in medicine, that is meant to universally improve quality of care.

The degree of physician dissatisfaction is leading to change. The multibillion-dollar companies that market the leading EHRs, understand that they need to make major changes in their software to improve the working conditions of the doctors. The first thing that needs to be done is to rebuild the interfaces that the doctors work with, to make them more clinically based. What does that mean? Ideally, a doctor should be able to spend the absolute minimal time recording the key medical findings in a patient. This is not about copying and pasting text from some  pre-prepared list of sentence options. It is critical that the EHR acts almost like a human assistant to the doctor, while he or she is recording the pertinent information. Pop-ups should only appear when they are warning the doctor about a real and significant problem, as well as when they can assist in documenting a particular problem and perhaps even helping by automating the ordering of various tests and consultations.

Ultimately, it is very easy to know if an EHR is successful. One simply needs to observe the doctors as they approach the computers. If the doctors look anxious and ambivalent, that likely reflects a fundamental problem in the way the EHR works.

Once clinical information has been recorded, and more so, imported from all types of wearable devices that are worn in the hospital and outside during a person’s regular day, analysis of all of this data can reap tremendous rewards. Therefore, by having  IBM working under the same roof with Validic and Athenahealth, it becomes possible to create a truly smart EHR. I can promise anyone who asks, that you will see doctors’ eyes open wide the first time they experience an EHR that can predict their needs, automate some if not most, of the critical documentation, preselect necessary orders based on the patient’s clinical background, and do all of this within seconds.

So for the first time in 30 years, I think the pieces are in place to graduate EHRs from passive recording devices to truly helpful assistants to doctors. It will require, still, a great deal of vision, drive and hard-core programming.  But the light at the end of the tunnel is finally visible. I for one will bless the day when this kind of EHR software is the standard. More importantly though, it is the patients who will bless that day.

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.