In his seminal 2009 book, The Checklist Manifesto: How to Get Things Right, Atul Gawande, M.D., lays out an incontrovertible case for a kind of healthcare delivery that eliminates chance, random decision-making, reliance on human memory, and the vagaries of process, in a healthcare industry still too reliant on all those factors in care delivery.
Dr. Gawande combines compelling anecdotes from his and other physicians' experiences, with narration of the kinds of research and other data confirming the need for checklist-based, protocol-driven healthcare. Early on in the book, he tells the fascinating story of how a horrific 1935 airplane accident led U.S. Army flight experts to create a first-ever pilot checklist, a concept that has gradually influenced many industries over time, ultimately evolving forward into healthcare to help save countless lives from medical and process errors every year.
In his introduction to the book, Dr. Gawande writes, “Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent…Knowledge has both saved us and burdened us.” The very complexity of patient care delivery, he urges, requires the use of checklists to improve patient care.
What strikes me as extremely significant right now is how the intersection of clinical IT and protocol-driven clinical care delivery processes is demonstrating more and more the potential for new approaches to improve patient safety and care quality, and support clinicians' ability to provide the best care. Indeed, it seems clear that the forward evolution of the electronic health record and other clinical IT products being offered by healthcare IT vendors, is producing more and more sophisticated, and useful, solutions every day.
Just look at the names of the vendors on this year's Healthcare Informatics 100 list-one replete with dozens of examples of truly innovative IT vendor companies, both clinical and non-clinical. The same is true of many smaller companies, including those our team has written about in our “Up & Comers” section in this issue-and it becomes clear that we are in a period of intensive innovation and discovery in healthcare IT. Of course, not every solution will turn out to be as solid or innovative as indicated by a press release or demo; such is the reality of market-driven innovation. But the forward progress of the industry is unmistakable at this point.
Consider the example of Zynx Health, the Los Angeles-based provider of evidence-based physician order sets and care plans for integration into EHR/CPOE systems. Scott Weingarten, M.D., Zynx's CEO and co-founder, and his colleagues realized back in the late 1990s that there was a strong potential market for providing a solution that packaged pre-vetted evidence-based medical order sets that could then be customized by individual patient care organizations, at a time when developing such sets from scratch has become increasingly impracticable.
There are literally thousands of other examples of healthcare IT entrepreneurs and developers turning such opportunities into innovation these days. This year's cover story package, including our unique Healthcare Informatics 100 compendium, as well as our Most Interesting Vendors and Up & Comers sections, offers our readers many chances to investigate all of this further. We hope you enjoy and benefit from this special issue of Healthcare Informatics. It is our privilege to bring forward this ensemble of coverage, for the benefit of our industry-and its patients.
Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 June;28(6):8
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