AMIA 09: CHCF president calls for more 'Kaiserness' to connect information

Lest anyone doubt that healthcare is in dire need of connected information systems, Dr. Mark Smith offers this reminder: "You can walk into the hospital where you were born and the first thing they will ask you is, 'Are you on any medications? Do you have any conditions.'"

That was but one of several memorable lines Smith, president and CEO of the California HealthCare Foundation, delivered Sunday during his keynote address to open the 2009 American Medical Informatics Association symposium in San Francisco. Patients are more tech-savvy than ever, but healthcare is mired in the past. "The only thing that we do the same way we did 20 years ago is healthcare," he said. There may be advanced medical technology in the exam room or at the bedside, but the data from the machines don't make it into the medical record unless a nurse or technician records the result. "When you order a book from Amazon, there's not someone sitting at the screen writing it down," Smith quipped.

Smith showed a screenshot from restaurant reservation site OpenTable.com, which, he said, "brings Kaiserness to a mom-and-pop operation" by interconnecting disparate sites like Kaiser Permanente has done--and the small business doesn't even need an IT staff to do it. "The restaurant owner did not have to come from a conference and get 10x10 certified before they can use the system," Smith said, taking a dig at AMIA's "10x10" effort to train 10,000 medical informatics professionals in the U.S. by 2010. (With a year to go, only a couple of thousand have finished, so it looks like the labor shortage in health IT will continue.)

Smith doesn't expect much to change unless healthcare does several things: embraces affordability--a concept that doesn't come easy to engineers like many the medical informaticists present; focuses attention on the technology consumer by understanding what end users really want and need; and ends what he called "analog limbo" by connecting data sources. "We have fast, smart, cheap machines connected to each other by slow, dumb, expensive humans," Smith said, to considerable laughter.

For any of these to happen, there needs to be healthcare payment reform, according to Smith. "As long as we pay for widgets--patient visits--we cannot expect docs to embrace technology-based care." And people in healthcare have to stop playing Whac-A-Mole, knocking down anything that might threaten their job security.

With the healthcare establishment so protective of its turf, it will be up to the next generation of doctors, nurses, technologists and administrators to be the disruptive forces. Addressing the younger members of the audience, Smith said, "My admonition to you is: Don't screw it up."