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Usable Health IT for Physicians

June 25, 2010
by John Silva, Nancy Seybold, and Marion Ball
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Smart point-of-care and comparative effectiveness research form the true basis for meaningful use

Executive Summary

A physician-specific point-of-care system that continuously adapts to practice patterns can potentially result in dramatic improvements to the quality and efficiency of healthcare delivery.

The major objective of health IT should be to subtract work, not to add work or make it harder. Most health professionals do not use available health IT systems because current systems fail to offer value. In 2001, the Institute of Medicine issued a landmark report that stated “to improve quality in health care, health care professionals needed to interact effectively and efficiently with the health IT systems.”

Unfortunately, the report's corollary, that health IT systems effectively and efficiently support clinical users, has not necessarily been the case. Clinical IT systems have adoption rates that are typically less than 15 percent. A recent HIMSS report, released by its EHR Usability Task Force in June 2009, concluded: “Electronic medical record (EMR) adoption rates have been slower than expected in the United States…. A key reason is lack of efficiency and usability of EMRs currently available.” Others have concluded that the current health IT efforts may even set back the vision of 21st century healthcare.

Underlying the conclusions of the above reports is the fundamental relationship between perceived value of an IT system and both the usability and utility to its intended users. A recent commercial for the Apple iPhone provides an important exemplar. A couple is finishing dinner and decides to go to the movies. With a few quick finger flicks, the couple identifies a movie they want to see, locates a nearby theater, and buys the tickets, all in less than a minute. The iPhone delivers immediately useful information-utility-and requires minimal effort by the user with almost no training-usability.

This kind of innovative IT is needed in health care. The iPhone's rapid and pervasive success is a clear example of how utility and usability are inextricably intertwined to provide value to the user. This goal can be met in healthcare with a Smart Point of Care (POC) concept that is designed to specifically address value for clinical users by providing immediate utility within an easy-to-use pervasive computing environment.

The Smart Point-of-Care System

Imagine a physician support system at the point of care (POC) that:

  • knows and uses the physician's context-where he or she is, what patient is being seen, what set of tasks need to be performed-based on locally relevant outcomes and measures;

  • supports all the coordination and scheduling tasks that the physician must “orchestrate” the patients;

  • is customized based on what information is entered, what the physician needs to see and what he does and closely replicates the way he thinks;

  • moves from device to device-installing automatically on whatever device is being used, scaling to the display, hardware capacity and operating system; and

  • connects securely to whatever source of information is required, whether electronic records, results or reference literature.

Clinicians are avid adopters of useful information technology and just want a product that can help them do everything they need to do at the point of care.

The fusion of efficient, best clinical practices and patient information at the point of care will directly support improved quality of care, and produce cost savings that have not been realized by current health IT systems. Savings and improved quality of care can never be realized if clinicians won't put the data in. Contrary to some conventional wisdom, clinicians are avid adopters of useful information technology and just want a product that can help them do everything they need to do at the point of care. Thus a clinician's work environment that actively supports intelligent provision of clinical data and information to and from its clinical users could become a highly leveraged interface to health and other systems that are needed to support the full spectrum of health services delivery.

Such a system could transform the healthcare sector and realize the true potential of useful IT. This work environment would support its clinical users by reducing the time it takes for purely administrative tasks while providing relevant clinical information and knowledge to the point of care, thus increasing the time available for a clinician to think about all the data and information about a patient and then, thoughtfully, address the patient's problem. It is not intended to increase the number of patients a physician or nurse can manage per hour, per shift or other measure of “productivity.” Although the overall timeline is shortened, the time saved is now available for listening to and talking with the patient.

The Smart POC system described above has other key attributes. It anticipates the clinician's needs and has data and information available before it is needed. It understands the clinician's context-dependent workflow. It also hides all the complexity of underlying health IT systems with simplicity-“magical” IT.

This context-aware Smart POC implements a systems engineering approach for the collection, distribution and maintenance of best practices, clinical data and system performance.

A conceptual architecture for Smart POC support is shown in the figure. The three components operate within a service-oriented architecture and exchange data within the Smart POC and to external information sources, such as local hospital information systems, health information exchanges (HIE) and knowledge sources, using standardized messages.