It's 2013. Healthcare information technology is far more prevalent and standardized then it has ever been in the past. Some concepts that have been evolving from other industries, as well as in healthcare IT, have important applications and implications.
The notion of doing things “in the cloud” has become a buzzword and an almost faddish term in recent years. Initially, it was used to put a new shine on old things. Simply storing information on remote servers as standard files was called cloud computing. Many of us are currently using services like Dropbox, Google Docs, SugarSync, etc. Similarly, connecting to a remote server as opposed to doing something locally on one's desktop or laptop computer is also dubbed cloud computing. An example here is simply web-based email.
In both philosophy and in practice, cloud computing has become something distinctly more and in some ways different. I'll highlight just two aspects of this, surpassing file storage (and even traditional database record storage), and transcending the tyranny of an implied single concurrent user.
Files and the closely related notion of document storage has become a terrific and convenient way to store and exchange information. Cloud computing has brought the availability and the expectation of concurrent versioning with undo and redo of multiple steps, and transcending the distinction from each end-user’s device.
For example, today I can open an existing file on my smartphone and add three sentences to it. Moments later, I can access that same file in its current and recently updated states on a tablet or laptop computer without explicitly opening it to undo one or two of the new sentences.
The applications are not behaving like old-school word processors, requiring me to open, save, and close the file. Instead, they are maintaining the transactions against that document, apart from and in addition to any static snapshots of that file. The result is the need to back up, send, print, continually rename, and other operational requirements of the old file/document/word processing metaphor are now gone. So are some of the tasks required to collaborate with others.
I referenced the issue of the tyranny of the single concurrent-user model. A common manifestation of this tyranny was that if one user opened a file, changed it and saved it back to a shared space on the network, they have the potential to overwrite changes made by another user during the same period of time. Someone's work would be deleted, invisibly, and unceremoniously, without any notification to any party involved in the process.
In the world of cloud computing, with applications designed and engineered to achieve the behaviors I’ve described, this lethal overwrite tyranny is replaced. Instead of having to resort to old-school techniques, such as “checking out a single copy of the document,” the cloud computing world surpasses that. When changes are made concurrently, either by multiple users, or by the same user on multiple devices, they are reconciled in real time.
Where there is a concurrency going on (actions happening at the exact same time, potentially in different places, and on different, often mobile devices by the same person or by different people, in cloud computing the divergence or “forking” of the document is automatically captured and maintained. There is no additional work, duty, or responsibility by the person editing the document.
This capability is adequately mature, in productive use, and available for no additional cost to hundreds of millions of current users of platforms by major providers including Google and Apple. In many cases, tens of millions of people are already using these cloud capabilities and not realizing they are there and how strong they are!
The availability, application, and integration to healthcare information technology, especially specific to documentation are less advanced, but likely to rapidly catch up. Of course, the definition of "rapidly" in HIT for providers is a lot slower than "rapidly" in the world of consumer applications and products.
In November 2012, at the AMIA annual meeting, there was a celebrated debate on the relative merits of health information exchange models. This debate included those primarily constructed to serve enterprise-to-enterprise HIE between healthcare providers and an alternative model that is more patient centered. The distinctions and challenges of ensuring patient information is available and important considerations like privacy were recognized and contrasted between the two models. There was a huge contrast among the presenters including John Halamka, Mark Frisse, Bill Yasnoff and Latanya Sweeney. John Halamka provides details here.
What was largely implicit in this discussion were the roles and responsibilities of the participants in terms of communication, task tracking, and decisions closely associated with the patient information being exchanged, shared, downloaded, or otherwise directed. That is true where the participants are patients, as well as when the participants are providers. This is part of the weakness, and in some cases failure, of care coordination today, which leads to such visible things as unnecessary readmissions and other gaps in care.
Mobile Computing and the Age of BYOD
In wrapping up this short list of what's becoming clear in the evolution of HIT, my final point is that mobile computing is more than just mobile devices (smartphones, tablets, notebooks, and intelligent connected everything else) and the ubiquity of wireless connections.
Let's skip the vanity battles over which devices are better and the privacy and security issues of hardening these devices. They are important topics, but addressed well elsewhere.
In the same way that “cloud” and “collaboration” are transcending their previous definitions, so is mobility. The implicit in mobility stems from the integration of global positioning services and related ubiquitous connectivity. A simple example of this is spouses routinely checking on the whereabouts of each other and their children using free services such as “Find My iPhone.”
Similarly, the unification of communication modalities (defined in detail here), including email, instant messaging, voice, etc., are making old processes obsolete and new ones compelling. Mobility and adjunct tools like mobile hotspots are making it practical for our pens, shoes, and other devices like Fitbit to facilitate, through the cloud and collaboration, new ways to track and encourage compliance, exploit social and gaming motivations, and otherwise redefine how we get things done. Many tasks can now be done better, faster, and cheaper.
1. Use videoconferencing instead of voice-only cell phone with your friends, peer collaborators, and direct reports.
Healthcare IT Consultant