This week I’ve taken vacation time to help my colleagues in Japan and New Zealand with national IT planning. As I often say, the healthcare IT challenges are the same all over the world, but the cultural context is different. In Japan, I spent 2 days in Tokyo and 1 day in Kyoto, lecturing, meeting, and listening to stakeholders. There is a great desire to share data for care coordination and clinical trials/clinical research. Telemedicine/telehealth is increasingly important in an aging Japanese society that has increasing healthcare needs but a limited number of caregivers and few opportunities to increase healthcare budgets. Here are a few of the current issues we discussed...
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Asking Better Questions and Improving Patient Engagement
By Kim Bellard | February 13, 2017
I've been thinking about questions. A few things I read helped spur this. The first was a blog post entitled "Asking the Wrong Questions" by Benedict Evans, of VC firm Andreessen Horowitz, Mr. Evans looked at a couple of long range technology forecasts (from as long ago as 1964 and as recently as 1990), and pointed out how they both managed to miss several key developments. He attributed this to "this tendency to ask the wrong questions, or questions based on the wrong framework." And we're still at it. Mr. Evans, whose background is mobile technologies, said that people are now doing a lot of speculating about what comes "after mobile," such as AR and VR...
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How to Successfully Enter Emerging Markets in Open Source Software
By VM (Vicky) Brasseur | February 12, 2017
In business speak, an "emerging market" is a market that is not yet well developed but on the rise and shows strong potential to be as robust as other developed markets. The Wikipedia definition focuses purely on countries, but this is a limited view of the meaning of "market." Whether a market is developed or emerging depends entirely on the product or service being offered and the receptiveness and awareness of a market to that product or service. For instance, Italy would not qualify as an emerging market by the Wikipedia definition. Yet, with an Internet penetration of only 58.5% of the country, it could be considered one for broadband Internet providers...
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Halamka's Health IT Observations from Japan and New Zealand
By John D. Halamka, MD | February 8, 2017
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Can the Healthcare System Change Its Spots?
By Kim Bellard | February 7, 2017
Just a few years ago, things were looking up for the American health care system. We were going to start finding better ways to pay for care: call it pay-for-performance (P4P), value-based purchasing (VBP), or similar terms. We were going to nudge -- or, rather, push -- providers into more clinically integrated systems (e.g., ACOs) to help improve outcomes and to control costs. And, of course, with wider use of electronic health records (EHR), we'd be able to better coordinate care and make decisions based on actual data. It all sounded very promising. Now, though -- what's that old expression about the leopard not being able to change its spots?...
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Postmodern EHR: Solving the feral systems dilemma
By Tomaž Gornik | February 2, 2017
Feral systems are software solutions developed by individuals or groups to help with day-to-day activities. They are called feral (or “wild”) because they are used in addition to core IT systems, working around key system architecture – more often than not without the blessing of management. I was first made aware of this expression a couple of years ago by Ewan Davis, who wrote a blog post about it stating: “The hundreds of “Feral Systems” in an average large hospital represent a goldmine of knowledge and innovation that could be harnessed in the design of digital systems that really work, but as they are today they also create a massive technical debt and create safety, governance and reputational risks for the organisation in which they are used.”
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Halamka Says "We Must Think and Act as One Planet"
By John D. Halamka, MD | February 1, 2017
Over the past few days, several journalists have asked me to comment about travel bans, immigration policy changes, and trends in isolationism. My opinions are my own and do not reflect any official position from my employer or my academic affiliation. Information Technology is global. We hire the best talent regardless of nationality, gender identity, sexual orientation, religion, or race/ethnicity. Having worked in 75+ countries in my adult life, I can say that innovation crosses all boundaries and cultures. It’s just as likely that next big breakthrough will come from EMEA as it is from APAC. I cannot imagine restricting the flow of collaboration among academics and technology professionals from any country...
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Diagnosing the Problem with Direct-to-Consumer Pharmaceutical Ads
By Kim Bellard | January 31, 2017
Quick: turn on the TV (no, streaming doesn't count!). You won't have to wait too long before an ad for some prescription drug comes on. Watch long enough and pretty soon you'll suspect that you have a variety of conditions that you may have never realized before and need to do something about immediately. Fortunately for you, of course, the pharmaceutical industry has solutions for you. It's all there in those ads. Whether we really understand them or not is another question. Direct-to-consumer (DTC) ads for prescription drugs are booming. After a brief respite during the most recent recession, they're back up, with spending estimated at some $5.2b in 2015 (amazingly, the DTC ads are less than 20% of pharma's overall marketing budget, with the majority of that going to face-to-face "educational" efforts with physicians)...
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Halamka's Recommendations for Effective Care Management
By John D. Halamka, MD | January 25, 2017
I recently joined the advisory board of Arcadia Healthcare Solutions, a leading provider of analytics, decision support, and workflow enhancement services. At my first advisory board meeting there was a rich debate about the marketplace for care management and population health tools. I’ve spent years studying such solutions at HIMSS and found most of the products are “compiled in Powerpoint”, which is a very agile programming language, since it’s so easy to change…
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Living in a Retro Health Care System
By Kim Bellard | January 24, 2017
EHRs are a perfect example of how we took something that should revolutionize health care, and turned it into something that not only no one is happy with but that many feel often impedes care, to the point some want to go back to paper records. That's not retro, that's just stupid. We didn't do the wrong thing with EHRs, we just are doing it wrong. As I've written before, we should be thinking big and bold about how we want our health care system to work in the 21st century. We should be setting tough goals for how effectively it works for us -- and expecting to achieve them. We should be looking forward, not backward...
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Halamka's Advice to the Trump Administration
By John D. Halamka, MD | January 11, 2017
As I've listened to the confirmation hearings for cabinet nominees, I’ve realized that no one with healthcare IT expertise has yet been identified by the transition team. I continue to ask all my colleagues about any contact they’ve had with anyone advising the new administration - so far, no one has been asked anything by anyone related to healthcare IT. At this early time in the administration, it’s important to offer advice as to the priorities ahead for the next few years. What would I recommend to the new administration?
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