As the year comes to a close, I've got simplicity on my mind.
The data tsunami is just beginning to hit healthcare. As I wrote almost a year ago, just enough technology should be our goal. But we also need to identify just enough data. That will be a much more difficult goal to achieve.
Big data is everywhere we turn. But big data requires big technology to analyze and make actionable. As one vendor quipped, what we really need is small data, the data that matters most.
The clinical quality measures coming down in Meaningful Use Stage 2—and now out for public comment, Meaningful Use Stage 3—are healthcare's version of the Amazon wish list, and if we're not careful, they will overwhelm fledgling efforts to find that actionable data.
The end of the year is a great time to pause and ask ourselves whether we are trying to gather too much data too fast, without having a real action plan.
What are some of the things we need to do the most? Some of these things are so rudimentary; they are hardly being discussed at all.
Take just one example: Electronic medical records. Electronic health records. Are they one and the same?
Again and again I see these terms used interchangeably, casually. I quote providers every week using one, or the other, or sometimes both. HealthLeaders editor Bob Wertz pointed this out, and I had to pause.
Healthcare technology is a complicated beast. We make it more complicated if we're using two terms where one will do.
It turns out that the Department of Health and Human Services' Office of the National Coordinator decided on a single term nearly two years ago. In a nutshell, EMR is the older term, dating from a time that the technology often represented little more than scanned images of paper documents.
EHR, the newer and preferred ONC term, encompasses the total health of the patient represented in a digital format, at least according to the ONC.
But in a phone call I had just yesterday morning, a doctor, who I won't name here, used the two terms interchangeably within the first few minutes of our conversation. I made a mental note, then when we were done talking about something unrelated, I brought this to his attention.
His response was that when he's sitting in front of a computer, he usually refers to it as the EMR, but when away from the computer and discussing care issues, it's usually an EHR.
This might seem like the smallest of peccadilloes to you and me, but to the public, it is one more reason to be fearful and suspicious of technology. If the pros can't agree on what to call something, who can blame them?
As technology finally makes its way into healthcare, the next great challenge is to simplify its use and even how we talk about it. The science behind medicine is an incredibly rich collection of ideas and language. But while we pour money into the science and the technology, we must also make it understandable to the beneficiaries, especially if they are to become part of the care team, which they must.
Simplifying is never easy. The EMR vs. EHR conundrum may remain unsolved, for example.
"The way I see it, the EMR is a subset of the EHR," says Rasu B. Shrestha, MD, MBA, vice president of medical information technology at the University of Pittsburgh Medical Center.
"At UPMC, we have several EMRs (one for inpatient, one for outpatient, one for our affiliate physicians and yet another one for our oncologists). I generally refer to the individual systems as EMRs, and the composite of all of the EMRs, along with the systems associated with the EMRs (such as the imaging platforms, interoperability solutions, labs, registries, etc.), together can be referred to as the EHR."
Shrestha notes that this is similar to the definitions offered up by the ONC in January 2011, which in the midst of its pronouncements left the door open wide enough for the EMR term to live on for some time to come.
So simple, yet so complex.
Again and again, the words we use to describe healthcare and the technology being deployed are loaded—with ambiguity, double meanings, and potholes waiting to trip up the next set of policy makers.
In 2013, another such word will be "identity." There is an effort, much needed, to uniquely identify patients as the healthcare system moves from fee-for-service to population health and accountable care. But no one can agree on which set of unique identifiers should be used to determine that unique identification.
Should it be one factor or two? Biometric or token-based? Can someone be anonymous yet unique? Identity technology mavens talk about "relying parties." How can we translate tech talk like that into something that doctors and patients can understand?
Do you own your identity, or is it something that someone else is entrusted with? It depends on how you define the word identity.
It's the adoption of health IT that allows caregivers and patients to become better owners of their data. But our headlong rush to adopt this technology is about to run into some profound hurdles that will make EMR vs. EHR look like a child's game.
Whether you rely on the Pareto principle (a.k.a. the 80/20 rule) or just KISS, we need to always remember what problem we're trying to solve.
Can the hospital quickly identify all the patients who are bedridden, or all the pregnant moms? If not, why not? We need to demand simplicity and power from our technology, not more complexity. We have to identify where the worst practices are happening. If our IT systems can't do that, how good are they really?
The challenge of simplifying all technology, including the crucial analytics technology featured in our December roundtable highlights, is the challenge of 2013. "We have to figure out ways to make this easier," says Joe Kimura, MD, MPH, medical director of analytics and reporting systems at Atrius Health.
Over the past year, I've spent hours listening to the recorded meetings of the ONC Health IT Policy and Standards Committees and various subcommittees and tiger teams. One such meeting happened on June 7, the Quality Measures Workgroup Clinical Quality Public Hearing.
Speaker after speaker, including Kimura, sounded a clarion call for simplicity amidst the technology tsunami. It is recommended listening, and since there's also a transcript, recommended reading as well.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.