E-mail is still the killer app.
But it will become the killer healthy app if Dr. David Kibbe has his way.
David Kibbe is a physician with an MBA and a history as an outspoken thought leader and change agent in healthcare. And he doesn’t like what he sees from the traditional enterprise approach to health information technology.
Kibbe has a vision for using technology to support patient care, and he helped to instill the four “guiding principles” of the Center for Health IT at the American Academy of Family Physicians.
According to the Center for Health IT, electronic health record (EHR) solutions must be:
- Affordable (for small and medium-sized practices)
- Compatible (with other vendor products)
- Interoperable (across offices, hospitals, labs, etc.)
- Allow for fair data stewardship (in which the physician and patient own the data)
When Kibbe looks across the health IT (HIT) landscape today, however, he sees numerous large systems integrators and complex EHR products vying to drink at the trough of federal stimulus money. There is very little interoperability between systems, and last year Kibbe in an open letter to President Obama stated, “If America’s physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the Babel that already exists.”
A simple, user-friendly approach
What he does want to see is a simple, user-friendly approach for doctors that will achieve the benefits of ubiquitous health information.
Is there an alternative that is cost-effective, easy to use and quick to market?
What about e-mail?
“Simplicity can be the lever that makes more collaborative things happen,” says Kibbe, and he has identified three important trends that could make a large difference in whether HIT is broadly adopted in our lifetime.
There are thousands of “non-users” practicing medicine today, physicians who find the current offerings intimidating and expensive. An industry organization called Clinical Groupware Collaborative was formed to identify affordable ways to bring HIT to this group of physicians. Their philosophy is that “there is value if there is a simple way for physicians to communicate, akin to e-mail.”
Secondly, there is a federal office called the National Health Information Network, or NHIN, that was formed in 2004 to devise secure and private standards for communicating health data. It quickly became a large, cumbersome network controlled by large enterprises with an evolutionary plan that could easily be another decade in the making. Fortunately, cooler heads have prevailed, and a new office, NHIN Direct, has developed a lightweight health information protocol using secure e-mail that provides an easy “on ramp” for providers and organizations.
Finally, there is an important provision in ACA (formerly known as PPACA, the healthcare reform law), called “meaningful use.” It provides a financial carrot to physicians over the next few years to participate in data exchange to support coordinated patient care, engagement of patients and submission of quality data. And if physicians don’t participate, then in a few more years there will be a financial stick in the form of penalties. Both doctors and HIT vendors are evaluating solutions based on whether they can quickly achieve meaningful use.
It’s like open source software
These three trends are converging around a vision of HIT that is more like the open source software movement than the old private email networks. Given the low-cost entry point of this model, it is more likely to see adoption by thousands of small physician offices.
Still, buying a system and actually using it are two different things, and to qualify as meaningful use, doctors must begin using the technology to do real clinical stuff, like contact patients, write prescriptions electronically, handle patient referrals and submit outcomes data. According to Kibbe, “adoption needs to approach 50% for a breakout scenario to become realistic.”
Not like Prodigy and AOL
Kibbe sees interesting parallels with the point in the early evolution of the internet when Prodigy and AOL were the only ways for consumers to communicate online. These were large, slow and ultimately non-scalable private networks that charged by the e-mail. They served their purpose for a few years but it wasn’t long before more nimble technologies and open networks replaced these behemoths. Soon e-mail was no longer just a novel alternative to the post office. It was a fast, cheap and safe way to communicate. It became the killer app.
If the stars align as David Kibbe and his comrades suggest they are, e-mail, a “back to the future” style of innovation may ultimately undermine the large EHR solutions. Once again it will be a killer app, but this time a healthy one.
What do you think about what David Kibbe is trying to do?