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The Age of Miracles

December 6, 2016
by Dave Levin, M.D.
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The age of miracles. 
The age of sound. 
Well there's a Golden Age. 
Comin' round, comin' round, comin' round! 

-TV on the Radio

We live in an age of modern miracles that we too often take for granted. I experienced one recently: routine cataract surgery. I started that day with a long-standing, severe cataract and worse than 20/200 vision in my left eye. By noon I was back home eating lunch and “Lefty” was clocking in at 20/40. That outcome is typical and repeated countless times every day. There is something profoundly miraculous in that normality.

In the course of my care I was treated with courtesy and genuine concern. The teamwork and overall efficiency of the process were remarkable. Safety best practices were followed consistently and cheerfully. The pain during and after the procedure was minimal. I also witnessed the role that healthcare IT plays in all of this and was reminded in a vivid way how far we have come and where we need to go. From that perspective there are still too many gaps in how information flows and is shared and this has an enormous impact.

Jennifer Schneider, M.D., my ophthalmologist

The range of technology on display during my episode of care was quite remarkable. I began to compose in my head a long list of items and related sciences that make this miracle possible: IV and other tubing (material sciences); Antibiotics, anti-inflammatory, sedative and ophthalmologic-specific medications (pharmaceuticals); high-end intraocular lens implant (materials and optical sciences), at least eight different machines that painlessly measured and recorded images, pressures, dimensions and whatnot and the ultrasonic knife used to obliterate the cataract (materials, optics, microelectronics, acoustics, advanced computing). The list goes on for quite a while.







Old School (top) and New School (near) ophthalmologic instruments in 2016. The devices in the second photo connect directly to the office EMR but that information does not flow to the outside world.

But, being me I was also struck by significant gaps in technology. Especially information technology. There’s still too much paper: everything from insurance cards to pre-op forms to the registration card for my state-of-the-art implant. I kept thinking, “Where’s my App?” and, “Why doesn’t that poor nurse have an iPad?” And of course the sadly perennial favorite, “Why do I have to answer the same questions so many times?” (This excludes the entirely appropriate repeat safety checks such as verifying I am who I am and that it is the LEFT eyeball we are operating on today.) It was clear that connectivity and sharing within each local IT ecosystem (office, hospital, ambulatory surgery center) is improving and it was equally clear that we still have a long way to go when it comes to sharing between them.

I happen to know from having lived in the 21st century that things can be very different. There are apps and all kinds of cool industry-specific devices. More often than not, they connect and collaborate more-or-less seamlessly. Amazon usually does know UPS just delivered my package. My ATM card works in China, Germany and my local grocery store. Base technologies and interoperability frameworks drive profitably and innovation.

Chinese physicians rounding with mobile devices in a hospital in Ningbo, Zhejiang, China in 2014.

In an article by published Oct. 5th, Marc Andreesen recently said healthcare is a “sector[s] with insufficient productivity growth, innovation, and disruption. You’ve got monopolies, oligopolies, cartels, government-run markets, price-fixing” and that this is why healthcare in general and healthcare technology in particular are not evolving at the pace of other industries.

I think he is correct on many counts though I would argue this is most acute in healthcare information technology (HIT). Clinical information systems especially are not evolving quickly enough and there are still too many technology “islands.” This is why I am so passionate about interoperability (and open APIs). I believe better interoperability will unleash the breadth and depth of innovation that HIT needs and simultaneously allow us to build powerful IT ecosystems by connecting the really cool technologies we already have.

So we truly do live in an age of miracles. I experienced one recently. But I can also “see” more clearly than ever that this golden age, at least when it comes to HIT, is still “comin' round, comin' round, comin' round!”

Dr. Dave Levin has been a physician executive and entrepreneur for more than 30 years. He is a former Chief Medical Information Officer for the Cleveland Clinic and serves in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors.


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