Groupware, Kibbe - Clinical Groupware

In The Health Care Blog, February 8, Dr. David Kibbe – family physician, geek, consultant, and former leader of the American Academy of Family Physicians software effort – describes health care software, which he calls “Clinical Groupware,” that,

• Is Web-based and networkable, therefore high scalable and inexpensive to use.

- Provides a “unified view” of the patient from multiple sources and information.

• Is designed to be used interactively – by patients and providers alike – to coordinate care and create continuity.

• Offers evidence-based guidance and coaching and personalized access to a person’s health data as it changes.

• Collects, for analysis and reporting qulity and performance measures as a routine by-product of its normal daily use.

• Aims to provide patients and their providers a collaborative workflow program for decision support.

• Creates a care plan for each individual and then monitors the progress of each patients and provider in meeting the goals of the plan.

This is my comment on The Health Care Blog in response to the Kibbe piece in its entirety.

I agree with Dr. Kibbe’s “clinical groupware” concept, and I applaud it. Groupware jibes with my biases:

1) that useful electronic health records will be market-based, not government-based;

2) that web-based clinical records will outpace, out-hustle, and eventually submerge propriety records;

3) that for every complex problem, there is a complex understandable solution.
Kibbe’s “clinical groupware” solution reminds me of the principles enunciated in the book Edgeware: Insights from Complexity Science for Health Care Leaders (VHA, Inc, 1998).

These insights include,

• Good-enough vision – build a good-enough vision and provide minimal standards rather than trying to work out every detail .

• Tune to the Edge – Tune your place to the edge by fostering the “right degree” of information flow, diversity and difference, connections inside and outside the organization, power differential and anxiety.

• Multiple actions – Go for multiple actions ar the fringes, let direction arise rather than believe you must be sure before proceeding with anything.

• Chunking – Grow complex systems by chunking by allowing complex systems to emerge out of the links among simple systems that work well and are capable of operating independently.

For every complex situation, in other words, there is a complex solution requiring collaboration and cooperation, and it is usually right.

P.S. - As I post this comment, I read in the WSJ that the Senate version of the stimulus bill has dropped support of computerizing doctors’ offices and a comparative research institute for measuring effectiveness of treatment. These were two cherished items in the Obama health reform effort.

P.P.S - I confess I do not champion ubiquitous EHRs or online systems to track every move a doctor makes or to document everything in a patient’s health record. To me, documentation is not the same as doctoring, and there ought to freedom to opt in or out of clinical monitoring.

I do not, in short, look upon EHRs or their online variants as the Holy Grail. I am, I fear, part of a contrarian minority, and therefore not part of an organized electronic religion, to wit, tongue-in-cheek, I submit,

Clinical software engineers constitute a religious cult,

Who believe algorithms will stamp out the medically occult,

In their minds geeks believe patient-doctor email,

Is one essential piece of the Holy Grail,

And, in their exalted opinion if you have Google,

You don’t really need the old noodle.

If you are looking for the right result.