The Future of Health Information Technology (HIT)

“All I know is that the Internet will transform the world.”

Alfred Chandler, Jr (1918-2007) Business Historian

I would like to bring your attention to one event and two medical articles.

1.A Robert Wood Johnson Foundation announcement that it is sponsoring an international competition to identify the 12 most disruptive innovations. Entries for the competition will close on July 18. You may enter by googling “Robert Wood Johnson, Disruptive Innovation” to review the current entries, one or which is mine. Mine is titled “Spreading The News of Health Care Innovation in Health Care.” Simply click on the "enter the competition" button and describe your disruptive innovation.

2.An article in the June 14 New England Journal of Medicine, “Communication between Physicians and Patients in the Era of E-Medicine” by John H. Stone, MD, MPH, deputy editor for rheumatology at UpToDate. The article concludes, “It is our task to ensure that e-medicine – now inevitable in one form or another – improves the ways in which we deliver, receive, and pay for health care.”


3.Another article in that same issue of the New England Journal “Information Technology Comes to Medicine,” by David Blumenthal, MD, MPH, and J. P. Glaser, PhD, of Massachusetts General Hospital and Partners Health Care System in Boston. Their article raises three questions: a) Will the Bush Administration’s current decentralized. market-based approach to promoting IT spread prove effective in meeting the promise of HIT? b) Can we rely on benefits of HIT to materialize when the market rewards those who can afford it and deprives the disadvantaged? 3) How will the health system assist 75% of physicians who practice alone or in groups of five or fewer so they can afford electronic health records?

Like most Boston medical elite, Blumenthal and Glaser trust the government more than the market. They prefer federal mandates and imprimaturs to marketplace vagaries. The trouble is that government has not provided physicians with sufficient incentives to install EMRs. Most physicians in small groups simply do not see how EMRs give a sufficient return on investment to justify their expense, which may initially run $30,000 per physician not to mention annual maintenance fees.

The demand side of the IT market (consumers desiring doctor use of IT) has yet to sway the supply side (doctors investing in and using IT equipment or expertise to supply IT information). According to the Wall Street Journal (wsj.com), the demand is there.

Consumers would like to see these IT services from doctors.

•77% would like reminders by email from their doctors when they are due for a visit or some type of medical care

•75% would like the ability to schedule a doctor’s visit in the Internet

•74% would welcome E-mail communicate directly with their doctor

•67% would like to receive receiving the results of diagnostic tests by email

•64% would like doctors to have an electronic medical record to capture medical information

•57% would like home monitoring devices to send medical information like BP readings.

Many patients expect these email services to be free. Most e-medicine models focus on online appointment scheduling, prescription refills, general messaging, and “web visits” with physicians.

These services are fine and good. Their chief benefit so far has been to reduce the number of telephone, Fax, and paper messages flooding into doctors’ offices.
Doctors may be missing a good bet by not stressing the value of the Internet as a mean of interactively educating and engaging patients about their care. The Internet and home held devices now allows consumers to receive interactive multimedia information – through visual, verbal, and voices messages – transmitted through videos directly related to their immediate problem, to an impending surgery, or to questions on how to use medical devices. Patients embrace doctors who communicate with them by giving them clear, understandable, relevant jargon-free messages in language and images they can grasp