Transforming US Healthcare and its Shadow Impact on Canadian Health Information Technology (HIT)

The OSCAR community was privileged to be the sole Canadian delegation present at Harvard's 2009 HIT Platform Meeting, chaired by Kennedth Mandl and Isaac Kohane, both of Harvard Medical School, and the launch of ITdotHealth (www.ITdotHealth.org), a National Health Information Technology Forum.

The meeting focussed discussion on how to best leverage the injection of $40B of stimulus money into the $20B HIT industry was led with keynotes by Mitchell Kapor, of the Center for American Progress and the founder of Lotus, Clayton Christensen, the Robert and Jane Cizik Professor, Harvard Business School and the author of "The Innovator's Dilemma" (1997), and Regina Herzlinger, the Nancy R. McPherson Professor, Harvard Business School and the author of "Who Killed Health Care" (2007), along with the participation of the White House's CTO, Aneesh Chopra, Google's VP, Research and Special Initiatives, Alfred Spector, Microsoft Health Solutions Group's Chief Architect Sean Nolan, Cerner's VP, Medical Informatics, David McCallie and numerous industry, academic and government leaders.

One consensus of the meeting was the adoption of the open source CONNECT project (www.CONNECTOpenSource.org) as a mechanism to deliver data liquidity between various open, proprietary, and legacy systems of traditional HIT over the New Health Internet, the NHIN.

Open source infrastructure is seen as a key mechanism to enshrine consumer protection, and as such continues to enjoy significant financial and political support from the US Federal Government. One can only hope that the Canadian government takes notice and follows their lead.

A significant challenge ahead of us all is the trend towards devolving health care excellence from the anchored center of expensive hospitals, out through focussed and efficient specialized clinics targeting the roughly 20 major areas of medical concern today, beyond to empowered community clinics and family medicine practitioners and directly into the hands of the actual consumers of health services. Acceleration of these efforts is intrinsically critical to the issue of cost containment and improved effectiveness of evidence based medical science.

Properly designed, technology is a valuable tool in the support and delivery of world class medical services. However, throughout North America, the deployment of flagship Electronic Medical Record (EMR) and Personal Health Record (PHR) systems are lagging and even government and industry programs to offset the costs associated with their deployment has still left us with the lowest adoption rates of EMR infrastructure in the industrial world.

Although easily dismissed as an issue of techno-phobic medical practitioners, one is constantly reminded of the fact that doctors don't have an iPhone adoption problem, doctors have an EMR adoption problem. Thus something is clearly missing, and this continues to be the source of much discussion.

EMR/PHR solutions have started their lives as record keep tools. These tools have grown to support inter system communication, and business workflow. As such, a modern clinic with EMR tools can run efficiently and effectively in a near paperless environment. Accessing legible and timely information in the charts is as easy in the office as it is from home. Billing and administration flows easily from the click of a few buttons.

Modern systems such as Canada's leading OSCAR family, encompass additional tools to improve communications with ones patients (the MyOSCAR patient portal), and amongst the expert community of the practitioners social network (the MyDrugRef social network platform).

The major question is what will drive the next wave of EMR/PHR platforms, to change the adoption dynamic such that they become pulled into use as ubiquitously as iPhones and BlackBerrys are today.

One promising trend is towards the evolution of HIT infrastructure into a generalized platform that supports specialized and numerous plugin applications and micro utility apps. As these apps become sophisticated decision support tools, especially when they are tied into workflow systems that deliver timely point of care support (which has been shown to be incredibly effective in use), one can expect that the systems will become must have components of the modern medical practice, large and small alike.

Similarly, this new platform, supporting secure data liquidity between all creators of content, will be essential in empowering patients to take control of their own health in ways that are not possible today. Managing one health care will transform itself from something that is done to you into something you do yourself.

Exciting days lie ahead of us all indeed.