Usable Health IT for Physicians

The heart of the architecture is the context/task manager (C/TM). It monitors user's activity to determine context, uses models of user's tasks and current/expected context to anticipate activities, tasks and necessary data exchanges with the user interface manager (UIM) and the information broker (IB) components, and maps user activities and tasks to the most appropriate support application for a true extensible software-as-a-service framework.

The IB component is the data/information cache for its users as well as the connection point to external systems. The set of services required by the IB is available in many commercial HIE or service-oriented architecture offerings from vendors. Both the C/TM and IB have analytic engines that monitor the efficacy and efficiency of user and system tasks versus outcomes to continuously enhance best practices and system performance. The UIM component presents relevant data, information and medical knowledge to clinicians and gathers data from them. It has presentation strategies to achieve communication goals that depend upon current context, criticality of message and device being used, adapts to the unique style of the clinician and provides a consistent set of metaphors regardless of the clinician's location. The Smart POC system is designed to automatically present relevant clinical data and information via pre-filled clinical widgets; offer executable patient care plans; unobtrusively collect patient data; and generate relevant charge or billing information as a byproduct.

This context-aware Smart POC implements a systems engineering approach for the collection, distribution and maintenance of best practices, clinical data and system performance. It uses clinician-specific and continuously-adapting practice patterns that have the potential to dramatically enhance the quality and efficiency of health service delivery. The systems approach addresses the very thorny and expensive issue of how to make practice guidelines/best practices relevant to local context and, at the same time, solves the “How can we maintain and evolve the practices that we have implemented?” question.

A well-designed medical home, and its underlying IT systems, will support physicians doing their job and reap the benefits of more effective delivery of care, and satisfied and healthy patients.

The built-in business intelligence and analytic tools provide clinicians and managers with a new mechanism that changes the focus from “what's been done” to “what should be done,” based on context and outcomes. This near real-time feedback loop simultaneously provides analyses for informed decisions about: what is best for my patients; what is best for our community, our state and our (population-level) nation; and best practices. Thus, the Smart POC enables an integrated evaluation framework that supports continuous feedback of outcomes, cost and benefit directly to the point of care-where treatment decisions are made by the clinician and the health care consumer.

User Expectations

Today's technology-aware users expect their devices to be nearly magical-like the iPhone described above. In many cases, fairly robust versions of software products are free, like Google Analytics and many web conferencing systems, or the international phone service Skype. As a result, today's users expect to access whatever information one needs, wherever and however one needs it, and execute useful transactions with no learning curve. The gold standard is instant access to online banking services, from an iPhone, in a seamless interface that just works to pay one's bills and manage one's finances.

Furthermore, a number of technologies have transformed business sectors other than health. Agile companies are realizing reduced costs, increased revenue, faster time-to-market, and increased customer satisfaction. They are capitalizing on Internet-enabled applications such as dynamic supply chains, customer relationship management, and emerging web services opportunities. Concurrent with that trend, cloud computing, vast grids of always-on computing resources, is fundamentally changing how companies purchase these IT components and services. No longer are businesses being held captive by expensive and proprietary hardware and software. They can access inexpensive, best-of-breed systems and services that are priced as commodities in the fast pace of Internet time.

New Practice Models

The U.S. health care system is a very large, $2+ trillion enterprise with many diverse business units. There is significant pressure to continue focusing on “sick care,” or treating disease. New approaches to delivering “healthy care,” such as the medical home (MH) efforts, are focused on coordinated, patient-centric care that integrates all the health services for their clients. A well-designed MH, and its underlying IT systems, will support physicians doing their job and reap the benefits of more effective delivery of care, and satisfied and healthy patients. Most of these capabilities are not available in any existing EHR system.

In addition to supporting the clinicians, there is a strong expectation that the MH will be the connection point for all interactions between the health consumer and his or her required medications, specialists and diagnostic studies. These users, like the iPhone consumers, have come to expect a high level of transparency and access to critical information in other aspects of their lives-particularly financial information. The health consumer in a MH environment will transition from a passive patient told what to do to a fully engaged and active partner in his or her care.