Time for a little heresy?

Amongst many of the news articles I read today, one jumped out at me (“The ‘silver tsunami’ that threatens to overwhelm US social security system” Oct 18th 2007, Guardian – http://www.guardian.co.uk/usa/story/0,,2193443,00.html). The moment we have been talking about repeatedly has arrived. The baby boomers are retiring.

I have lost count of how many positioning presentations I have either given, or sat through that called out this moment as the coming challenge and a serious source of concern for healthcare. Usually (and and my presentations are included) the presentations are centered around the need to invest in technology to help reduce the burden on the system by consolidating information, and reducing the “waste” within the system, such as re-ordering laboratory tests. Large scale technology projects will remove the problem and save our budgets.

Over the years I have been involved in technology in healthcare and have friends and colleagues involved in large scale projects in both Canada and Europe, in particular in the UK. There are some very complex and noble designs on the table, which stand to greatly improve both the delivery of healthcare and costs associated with healthcare when they are completed. But here’s the rub; these are expensive and complex projects, taking many years to design and implement. Realistically a large scale jurisdictional Electronic Health Record project can take upwards of a decade and multiple millions (choose your currency) to deliver.

Now for the part that might get me burnt at the stake; is there a more efficient way to achieve the desired end-state? Might a better way to achieve an Electronic Health Record (EHR) be to use a series of small projects to provide clear incremental steps rather than a large centrally controlled project? What about enlisting the owners of the data within the system; the patients?

I have to admit to being suspicious of large organisations setting up “free” or even subscription based Personal Health Record (PHR) systems (see Google and Microsoft) but there may be something in it. True, a PHR doesn’t provide all the benefits of a full blown EHR (especially around Performance Management) but that ultimately is not a concern of the patient. 

So while we design, build and deploy large scale Electronic Health Record solutions, maybe Personal Health Record systems have, at a minimum, a stop gap role to play, even in a non-competitive market?

I hear the crackle of fire.. gotta run!

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