This week in health IT: Halamka, Reider, more on advancing

The Medical Informatics World Conference was held in Boston this week and the speakers shared interesting thoughts on incorporating new technologies in healthcare.

For example, to keep a focus on innovation while managing the long list of federal mandates in healthcare,  John Halamka, MD, CIO at Beth Israel Deaconess Medical Center (BIDMC), said incorporating newer technologies is essential. Specifically, he addressed “SMAC”—social, mobile, analytics and cloud technologies.

BIDMC has been using social media to expand on the idea of the care team approach by employing Wikipedia-like documentation. Care team members all contribute information to the patient record with one clinician curating the information and signing off on the record. “The idea is that many people create wisdom in a crowd,” he said. “We’re starting to break the paradigm of one EHR, one doctor with this social media, team-based approach. It’s important that we share everything we write with everyone on the team including the patient. It has worked really well.”

After spending years creating EHRs and getting structured data, mobile technology is changing the landscape. Halamka said clinicians at BIDMC are using Google Glass in the emergency department. They log into a secure portal and the tool lets them scan a QR code and they are authorized to access the patient’s record. Every room has a QR code on the wall. “Google Glass recognizes where I am and therefore, recognizes the patient,” he said.

BIDMC has approximately 3 pedabytes of data and has been using analytics tools that help users mine the data and guide care more effectively. “Big data isn’t big anymore, we just need better tools for analyzing it.”

While many in healthcare are reluctant to adopt cloud technology because of privacy concerns, BIDMC has been creating its own private clouds, Halamka said. That allows for services at a low cost and he noted that most clinicians don’t have the expertise to keep servers in their offices.

Much of the latest technology aims for a pleasurable experience, said Jacob Reider, MD, the Office of the National Coordinator for Health IT’s chief medical officer, such as autocompletion of texts and the user interface of the iPhone, which anticipates users' needs. However, “maybe it’s not safe.” For example, the autocomplete function could incorrectly finish the name of a drug. “Safety is an important component of usability. We want users to derive pleasure but it’s more important that they be safe.”

Physicians might complain that technology is too slow, but Reider said that could be a good thing. “Sometimes slow is better,” especially when it forces users to double check their selections.

Reider also addressed the gap between quality measure expectations and EHR capabilities, which he deemed quality chasm 2.0. The paper record allowed for searches of certain information, he said, but while EHRs probably contain the information they can be more difficult to search. “To fill that gap, we need to change where we are in terms of availability of information.”

Regarding EHRs, “usability is not where it needs to be,” Reider acknowledged. "When we create digital records and pretend to anticipate all the needs of clinicians, we make mistakes. We think we’ve anticipated all the questions that can be asked but we really can’t and then we destroy the usability."

When it comes to the questions of what matters and to whom, “patients need to be driving the bus,” he said. The “shift left”—away from hospital care toward greater patient engagement—leads to increased quality and lower costs, he said. The greater flow of information means that primary care providers now have access to evidence-based care that “used to be trapped between the ears of specialists.”

Beth Walsh

Clinical Innovation + Technology editor