Roadblocks for Application Developers—Costly, Complicated Infrastructures
Major healthcare facilities with significant IT budgets such as Kaiser, Mayo, Cleveland Clinic and others have the ability to provide customized environments for their care providers—EMR workarounds. While these customized solutions are relatively simple, they are very specific to one environment. They are also costly to develop, adaption to a new environment is challenging and only the big healthcare organizations can afford them, not a community hospital. The complexity begins with lack of EHR interoperability, but it is not the only difficulty.
Most care environments require the support for a messaging or notification service, a polling service to trigger notification if a patient’s condition changes. Such services are common and can be shared among healthcare applications. With most of these common services pre-developed, applications developers can focus on innovating solutions for providers to improve patient outcomes and reduce operational costs.
Healthcare needs healthcare applications to address providers’ needs in diverse care environment. We must remove the roadblock so that application developers can focus on healthcare innovation. It is the only way to improve patient outcomes, reduce costs and increase providers’ efficiency and scalability. Only healthcare applications would address care collaboration, patient engagement, and all the challenges being long discussed, but no solutions exist in today’s healthcare industry.
Consumer and Patient Centric Model
Dell Computer’s success has been based on a consumer centric model for computer purchasers. This model changed how computers were built, delivered and supported. Dell’s computers are designed based on that model, beginning with part inventory, hardware designs, manufacturing, and delivery through to customer support.
This process has propelled Dell Computer to a leadership position, but above all, changed the consumer expectation. From the consumer perspective, Dell represents applications aiming at improving personal computer purchases along with all the supporting capabilities.
In healthcare, we often talk about a patient centric model. Its challenges begin with a lack of EHR interoperability. Each patient has their own set of healthcare facilities where there records are kept. These records are supported by different EHR systems from different EHR vendors.
This is where the patient medical information flow begins, but it does not stop there. Each patient has different healthcare needs from different care environments where care providers’ collaborations are different. Each of these environments requires different processes to focus on patient care.
Here are two examples of healthcare’s current state in terms of a patient centric model.
– A patient is discharged from a hospital after a surgery. The discharge report instructs that the patient checks in to a wound care center for follow-up. In today’s environment, there is no support for ‘patient follow-up’ and ‘anticipation of potential healthcare problems’. What if the patient does not check in to the wound care center? What would be the patient’s challenge to get to the wound care center? Hospitals and clinics are incented to provide such follow-ups and hand-offs between healthcare facilities, but there is no application or mechanism to support its efforts. At best, it would be a manual, human intensive engagement.
– A patient checks in to emergency room for a bone fracture. The emergency room physician deems that a general doctor can handle the treatment the next day. An x-ray is taken and some basic check-ins are done at the ER. The patient shows up at the general doctor’s office. What are today’s capabilities for such seamless hand-offs from an ER to a general physician?
These are simple examples of a patient centric model. There are huge benefits for such seamless engagements as noted in the CMS care guideline.
Addressing Healthcare Based on a Patient Centric Model
A patient centric model needs to be supported by applications. Healthcare applications are required to support a seamless process across multiple healthcare facilities. Such applications need the support of a seamless medical information flow, personalized on a per-patient case like an airline or a bank has.
Healthcare applications are missing. Health IT organizations cannot fulfill their support to medical professionals. Patient centric models have been a theory, or at best, supported by manual processes, exposed to human errors. Healthcare application availability has been limited by the healthcare infrastructure and the lack of common services mostly available for its siblings in other vertical markets described earlier.
Not Just Generic Middleware, But Healthcare Middleware
Healthcare applications face different challenges than their counterpart in consumer applications. They are not designed to replace providers or to improve the efficiency and scalability of providers. EMR and EHR systems have common characteristics with a database system, but they are designed for healthcare. In other words, healthcare needs its own stack.
Healthcare middleware must address all the common services required to support application development. Having a set of APIs access EMR and EHR systems is the starting point, but not the complete solution. Messaging, workflow, rule engine services, and more must be part of a middleware solution. Its footprint must be lightweight and cost efficient so that it can be embedded with the applications.
The real healthcare challenge is addressing the missing healthcare applications in support of a diverse care environment. Our efforts must align to inspire developers in addressing providers’ needs. It will be healthcare applications that will evolve healthcare to the next level.
Dr. Donald Voltz is a board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.
