Totally wrong. The reason the US healthcare system sucks is that it's an oligopoly. Medical schools limit enrollment to limit the supply of doctors thus keeping salaries higher than they otherwise would be. Nurses unionize to drive up their own wages. Insurance companies pile on the paperwork because they can charge you for it. Doctors are incentivized to push more expensive drugs and procedures because they make more money. Drug companies develop drugs that will make them the most money and wine and dine pharmacists and doctors to ply their drugs. Thus those that can pay end up paying more and more. Those that cannot get no coverage at all. Oligopolistic capitalism at its finest. Everyone in the system gets paid off a bit to not rock the boat.
Go back one item in his posts, to <a href="http://delian.io/an-apology-to-president-reif-and-the-mit-community" rel="nofollow">http://delian.io/an-apology-to-president-reif-and-the-mit-co...</a><p>"..."<p>I can't imagine trusting this guy, or anyone willing to work with him, with ... anything, let alone implicit and explicit access to medical information, until he presumably grows up a bit a decade or two from now.
I've worked in the Health IT space for 15 years and agree with you that it's a mess. But your POC site doesn't really show anything or explain how you're going to solve the problems you described. How is this information shared with physicians? How is it made available when a patient shows up to the Emergency Dept? All of the information you displayed should be condensed to one page. What is the point of knowing if a patient missed their meds three weeks ago? You can't berate a 75 year old for missing their meds. What you're recording isn't as useful as you think.<p>The problem population today is elderly patients with chronic conditions, either landing them in the hospital constantly or requiring regular visits to specialists, labs and pharmacies. This population does not use smart phones. So the burden is on the physicians and hospitals to track the information and coordinate care.<p>The whole idea of Accountable Care Organizations (What you described as "The New Model") is to coordinate care. ACOs are pilot projects, most just barely starting up. So the reality is only a fraction of the population in the US will be affected by these organizations. The big workflow change is really for the nurses who gather the information, not the physicians. The goal of ACOs is to improve outcomes. ACOs receive bonuses if the can improve outcomes for the same cost or less that is being paid for the same population today.<p>Also as a FYI, everything you described as Obamacare (ACOs / EHRs) was actually developed and funded in 2009 by ARRA, not last year in the ACA / Obamacare.
Delian - love the initiative!<p>There are a few basic assumptions underlying your vision that may be useful to flush out further (I can tell you that, from similar experience, what you are going to bump in to is a fundamental lack of desire from the majority of the system to see change).<p>1. You are betting that Obamacare will actually drive the system towards "accountable" care -- we are a long way off from this unfortunately. I won't rehash it all here, but many ACOs are turning back from the model: <a href="http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=7540007960" rel="nofollow">http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?...</a><p>2. You are betting that patient engagement in their own health will be high, particularly for the high cost, at risk patients. This has been historically proven not to be the case. High touch intervention + technology works (i.e. take a look at the Diabetes Prevention Programs now being run digitally by organizations such as Omada) but technology by itself has had a pretty low hit rate with driving meaningful patient engagement for the at risk populations. For some reading on the challenges of adherence, check out: <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/" rel="nofollow">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/</a><p>I really do think we need more people working on these problems, so keep at it, and if I can help at all please let me know!<p>(drop me a line at andrei@humanapi.co)
Although I agree that EHRs largely suck, it is not the elephant in the room. From a technology perspective, if you really want to fundamentally change healthcare then you have to tackle diagnosis. For the majority of illness and disease, we still do not have a good set of technologies that diagnose accurately, quickly, and cheaply. Instead a physician makes an educated guess based on symptoms and sometimes on tests. Tests which give clues but rarely a definitive answer.<p>I don't know what the answer is, but I know that the sooner we take the "art" out of medicine, the sooner healthcare will get a lot better.
Interestingly enough, the picture you showed is of VISTA used in the VA hospitals, which is generally considered to be the most usable EHR by clinicians. An ignominious honor, perhaps, but it's worth consideration. 60% of doctors know how to use it, since most doctors do some type of rounds through a VA hospital since it's the largest medical system in the United States.<p>You're right, most EHR UI is bad and it's built upon old technology. It entirely pre-dates the "design era". But, part of the reason for this is that healthcare was one of the first major industries to use IT heavily. What these systems lack in modern design principles, they often make up for in stability and ability to support system flows for larger organizations.<p>I admire your spirit and I hope that you do make an impact on healthcare. But, it might be wise to try and glean some lessons from the past vs. writing everything off as something that "fucking sucks". You might learn something along the way on your path to making health delivery better.
This guy is a huge jackass.<p><a href="http://delian.io/an-apology-to-president-reif-and-the-mit-community" rel="nofollow">http://delian.io/an-apology-to-president-reif-and-the-mit-co...</a><p>I wouldn't have anything to do with him or his company.
>> I want to one day build a clinic run without an EHR. All of the personal health data of a patient will be stored on their phone. Each time they come into the office, they’ll give OAuth access to one of our physicians...<p>I like this idea, but patients vary wildly in responsibility. You'd have to have a plan for those who can't or won't keep track of anything.
Something to keep in mind is that many people with the worst health prospects/problems (e.g. Medicare/Medicaid patients) are the least tech-saavy/have the worst access to tech-enabled solutions to addressing their health problems. These patients make up a non-trivial portion of any provider's patient list.<p>Kudos!
One correction, or whatever.<p>The fines did not force more doctors to look at EHRs, it forced many like my Doctor and those in his office complex to sell their practices to big Medical conglomerates. So from a complex of multiple independent practices, many decades old, they all sold. Now they are employees of these conglomerates and there is now staff who deals with EHR, they just ask for print outs and fill out forms.<p>As for Doctors suddenly becoming responsible for managing their customers care, well that will lead to less individual practices as they won't be able to afford those patients who cannot be managed.<p>Your now a number to be managed. Fortunately for me my Doctor remembers his long term patients. He will be here till they finally force him out.
What happens if you are brought in unconscious?<p>Every so often people come up with this idea of the patients holding their medical information rather than the institutions but they tend to suffer greatly in emergency situations and/or have tortuously complicated hierarchies of trust and security.
How do you stop patient's from deleting health information they deem 'not important' or 'too embarrassing'? I think it is important that health professionals keep their own records of patient health.<p>Although, I do agree software in hospitals is NOT user friendly!
It's going to be hard to effect the "change" so many are seeking when folks continue to confuse and conflate "health", "healthcare", "the healthcare system" and "health insurance."