People love using analogies when talking about areas that are new, abstract or controversial. Not surprisingly, the nation’s health information technology infrastructure, having all three characteristics, is prime fodder for this game. If done well, analogies offer insight and specificity and if not they can be confusing and even comical. The game of health technology analogies has been restarted of late on the Web, so with hope for more insight than comedy, let’s pick health technology analogies for $200.
One analogy that is now circulating the Web compares the electronic health record (EHR) incentive program as the health technology “equivalent of cash for clunkers.” The author’s intent is to point out that the physician and hospital incentive funds might be a heavy investment in out-dated LAN and PC technology in a web and web services world. Most, however, seem to see the incentives as an important, if blunt, “tipping point” for moving forward.
The Nationwide Health Information Network has been a frequent analogy target and recently one Web columnist stated that the new “NHIN Direct” project is “like a secure Internet Service Provider (ISP)”. The NHIN Direct is an all “push” approach to health information exchange that its proponents describe as “replicating existing fax workflows.” I am not sure these qualities make it “like an ISP,” but another columnist is even grander in saying that NHIN Direct is “…getting to the health Internet, finally”. A more restrained analogy for NHIN Direct is that it will be “like secure email.” Being “push” and “point to point” some of the email analogy seems to fit, but, on the other hand, NHIN Direct is not intended to support “person to person” as much as “system to system” exchange so it will not manifest the interactive and iterative communications properties that make e-mail useful. Health information exchange also has to be, at some point, about processable data and not the exchange of text notes, so I am not sure the analogy to secure email works well either. Perhaps NHIN Direct is most “like secure FTP”?
Rolling right along then, what is the right analogy for “NHIN Classic”? In this case, I am referring to the “look-up” and “push” web services that are also implemented in the NHIN Connect software. The look-up portion that draws together different pieces of a patient record from different places has been “likened to Google”, but, that being said, “NHIN Classic” is still restricted to connecting government contractors to government agencies, so I guess that would make it more “like ARPANET”?
Raising our sights a little, what is the analogy for the systems that are to support providers’ needs in the health reform paradigms of “accountable care organizations” and “medical homes”? The technologies must provide, among other things, a communications and recording platform for care teams. I don’t think we want to put health record “listservs” on top of “secure email” do we? Just imagine the “blast emails” that would create! The technology analogy also needs to integrate information from multiple settings and be patient centric. So I guess that makes it “like a secure Facebook wall.”
Of course, healthcare is more complicated than my daughters’ social lives (at least a little bit) and there are particularly complex issues about where patient records reside. Storage is especially challenging in a hospital – affiliated provider, government – private sector, and patient “control” contexts. Perhaps part of the answer is to strategically separate the records from the applications and have a health record services standard that allows read – annotate access for patient records that are retrieved through authorized EMR or Personal Health Record (PHR) applications. That would be kind of “like RSS,” eh?
John W. Loonsk, MD FACMI is Chief Medical Officer for CGI. He has also held leadership positions as Director of Interoperability and Standards in the Office of the National Coordinator in Health and Human Services, as Associate Director for Informatics at the Centers for Disease Control and Prevention, and in two major academic medical centers.
