Sunday, April 19, 2009

Interactive Everyware Health Care, Web 2.0, Usability, & Electronic Medical Records: The Story. Part One

There has been quite a buzz about the economic stimulus plan and the impact it holds for health care, including health care IT. I wonder if there will be significant, positive changes.


There is a long history of user-unfriendly health-care technology. If you work in the health care field, you probably know that the U.S. government spent several billions on AHLTA, the Department of Defense's electronic health record system. The end result? A user-unfriendly mess that caused a "near mutiny" of health care providers who had been "victimized" by AHLTA's poor design and unreliability, according to a 3/29/09 article written by columnist Tom Philpott, "Electronic Records Headache for Doctors."

Similar articles have been written about this problem:

AHLTA Continues to Disappoint

AHLTA is Intolerable: Tom Munnecke's personal account of the history of healthcare IT in the military. Munnecke doesn't complain too much, and he offers some solutions, as he's been envisioning user-centered health-care IT design for a very-long time:

"Focus on a personal health record approach, designing the system around the individual, not the bureaucracy treating the individual. This business of creating outrageously complex, expensive, and brittle enterprise systems is great for the beltway economy, bad for the patients and taxpayers."

Munnecke was one of the architects of VISTA, the Veterans Health Information and Technology Architecture, which was introduced in 1996 and met with much more success than AHLTA.

A New Vista for AHLTA?
"An MHS poll, Casscells added, showed that AHLTA now has become the biggest issue of concern for military clinicians, ranking above treatment for troops suffering from post-traumatic stress disorder."

Tom Munnecke, in "Some thoughts about the future of health care IT", stress the fact that the purpose of technology in health care is to facilitate communication, that health care is more than "records".

" The building blocks of the system should be around the flow of activities leading to a desired goal - a transformation - rather than an assemblage of discrete events - the transactions. I talk a little bit about this in
Transformational Ensembles“ This model is based on the notion of an ensemble of people and resources collected to achieve some transformational goal. An ensemble may or may not be a formal clinical provider, a hospital, or health care system. It might be an AA support group, a community volunteer group, or a family...Our information systems should be designed around our health transformational goals and the individual - not the enterprises delivering the care."

Munnecke goes on to discuss how we need to conceptualize technology in health care as a "space" in which systems emerge, rather than imposing systems that have contributed to the "medicine by bodyparts" approach and health care documentation processes that could lead to perversing the way health care is delivered and accessed.

"I think we need to create a space within which health information and activities can exist, and let systems emerge from that space....If we were building cars, it makes sense to talk about the optimal system for the assembly line. Raw materials go in one side of the factory, and finished cars come out the end. It is tempting to apply this systems model to health care: sick people go in the hospital, and well people come out the other end. This leads us to “medicine by body parts” - care of our teeth, for example, is entrusted to an entirely different health care education, training, insurance, and business system from the rest of our body. I talked a little about this in a 1999

For more information, see Munnecke's Eclectica blog

Pervasive and Ubiquitous Access to Health Care, Health Care Information, and Health Care Records

A nurse who can seamlessly interact with her on-line life through an iPhone knows how good usability feels, which is the opposite of the feeling many health care workers have when they interact with present health care information, which are not user-centered in design nor user-friendly.

I am crossing my fingers in the hope that some UX designers will be included in the the health care IT conversation. If not, it will not be beneath me to do some begging and pleading.

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