Monday, November 2, 2015

Information Technology Moves the World But It Doesn’t Integrate It

Give me a place where to stand, and I will move the earth

Archimedes, 287-212 B.C.

The greatest migration in the history of the earth is underway, and its lever and trigger is the cell phone.

There are now more refugees – 60 million, than any time in recorded history (Rod Norland, “Mass Migration Crisis, And It May Get Worse, Millions More Poised to Flee Turmoil at Home,” New York Times, November 1, 2015).

When immigrants' boats wash upon European beaches, refugees immediately reach into their pockets or socks or under their belts, to retrieve their cell phones, which are often encased in waterproof packets. They call home, tell relatives they’re safe, say things are better here, and here’s what you have to go to get here, thus setting the stage for millions more to come.

Cell phones, the IT technology they represent, are literally the lever moving the world’s people. Immigrants are coming from everywhere to Europe – Iraq, Afghanistan, Yemen, Eretria, Libya, Egypt, West Africa, even Haiti.

They are fleeing persecution, poverty, strife, religious intolerance, dictatorships, and war. Their preferred destination is Western Europe , with its generous social welfare programs, which, for the moment at least, are overwhelmed, thanks to their fabled largesse.

But it's one thing to receive, process, house, and feed the terrorized hordes. It's another to afford their care and to integrate them into society.

IT is great for reaching millions, even billions, through the Internet, iphones, and personal computers. It's not so good at sorting out the information, and leveraging it for efficiency and for the common good. Compassion has its costs and consequences – such as loss of national identity.

In the U.S. in health care, we are finding out how hard it is to integrate the data and new information across “the continuum of care,” from birth until death.

IT creates often unfathomable issues - how to pay for IT systems, how to make sure data is accurate, how to implement it with disrupting patient-doctor relationships, how to assure the information is “unhackable,” how to protect personal security and privacy, how to guarantee the various systems are interoperable.

George Halvorsen, CEO of Kaiser once told me his organization had pledged $4 billion so that every Kaiser clinician would have every Kaiser patient electronic health information at their fingertips.

This pledge is a good thing. It's an example of IT power for the good. The reasoning goes, you can never have too much good information.

But even good information isn't simple to implement, or to make its various components and systems mesh. Or to make IT data and information understandable to patients or other audiences you seek to reach and influence.

ObamaCare, with its vast audiences and its website, which tries to integrate information from other federal IT systems, has learned this lesson the hard way, with its disastrous launch and its subsequence lurches into inoperability.

So has the VA information system, “Once cutting edge, the Veteran Health Information and Technology Architecture (VistA) electronic health record (HER) has been stagnant for a decade, and clinicians are frustrated with the lack of integration and mobility compared to commercial systems.”

The VA system inflates costs, lacks interoperability, and isn't properly integrated with other Department of Defense systems. ("Reforming the Veterans Health Adminitration - Beyond Palliation of Symptoms NEJM, October 29, 2015).

The iphone is a powerful lever and starting point in the IT revolution for immigrants and some patients and physicians. Individual interconnections are wonderful as Facebook and Twitter billionaires will attest. But access to IT is just the beginning. It's just the start of the end of the beginning.

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