Billions Spent on HIT Stimulus Could Lead to Major Boom … or Bust

The more than $19 billion of funding provided for HIT in President Obama’s economic stimulus package offers a unique opportunity to deliver on the promise of computerized healthcare, say researchers from Children’s Hospital Boston in an article published in the March 26 issue of The New England Journal of Medicine. The coauthors argue that the development of a platform model—drawing on the success of software platforms such as the one created for the iPhone—could create a flexible health information infrastructure that will improve delivery of healthcare, increase physician productivity, foster advances in science, as well as stimulate job and economic growth.
 
“This is a critical point for health IT,” says coauthor Kenneth Mandl, MD, PhD, of the Children’s Hospital Informatics Program (CHIP). “Pouring money into existing health IT systems would be the most natural approach to take with the stimulus, but it may also be the wrong approach. We need to pause and make decisions that will have long-term benefits. Rather than simply deploying existing technologies, we need to establish clarity on what the characteristics of an ideal system would be.”
 
In their article, Mandl and Isaac Kohane, MD, PhD, also of CHIP, propose for the government, through Health and Human Services, to mandate the development of a platform that will support applications for clinical care, public health, and research. Much like the software platform developed by Apple for the iPhone, or the Indivo platform created by CHIP researchers that has emerged as a model for personal health records, the coauthors encourage HHS to mandate the creation of a platform that will support an ecosystem of applications (ie, order entry systems, medication reconciliation systems, patient communication systems) that can be developed by existing vendors or new HIT developers. The platform they suggest would support the following:
 
• Liquidity of data;
 
• Substitutability of applications;
 
• Open standards; and
 
• A diversity of applications.
 
“Current systems are monolithic, inflexible, and not able to be easily customized to meet healthcare providers’ needs,” says Kohane. “A model that supports substitutability will encourage competing applications, market innovation and evolution, and give providers the freedom to use/not use applications as they wish. With such a model, if one application doesn’t have what you need at your institution or practice, you could easily find and download one that does or send out an RFP and one could be developed.”
 
The development of such a model could stimulate HIT and the economy, the coauthors note, as more vendors and developers are able to participate in its success and growth. Such an approach and investment by the government, they predict, would be catalytic to healthcare as we know it.
 
Source: Children’s Hospital Boston

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