Thoughts on a burgeoning (or fatigued) space

Every morning, as I wave my badge in front of the security clearance device by our office front door, I can't help taking an extra glance at the printed sign next to it labeled "Information Technology." Normally this wouldn't raise any eyebrows, except for one notable fact - I work for a major academic hospital.

These are new waters for me - for much of my undergraduate career, the thought that my first real job would have anything to do with the word "technology" never crossed my mind. The one CS class I took my senior year made me both terribly sleep-deprived and absolutely miserable. This was made even more certain by my firm belief that I was ultimately headed for medical school. I was going to be a doctor who healed patients with drugs and touch and words, and even though I knew I wanted to take time off before returning to school to explore the health field, that time was neatly limited in my mind to no more than two years, doing something within the counventional boundaries of the field (junior researcher, policy intern, academic assistant, etc.).

So it's with a bit of wonder that I ended up here, in health care IT. In the title, I referred to this space as both burgeoning and fatigued. In one sense, IT is the new buzzword in health care. Digital medical records, patient-oriented interfaces that allow them to email physicians, have visits online, check test results, and access online medical information databases (e.g. WebMD, a new and very spiffy tool called Medpedia) are the hottest things. As a field that has long included diverse players ranging from ethicists to engineers, health care is soaking up ideas such as crowdsourcing and social networking.

On the other, the oragnization and planning behind some of the ideas is still quite poor. As a health care system, we have no vision for how to digitize our provider networks so that communication flow leads to improved outcomes and lower costs. Pharmaceutical companies are taking advantage of this gap between providers and patients to directly advertise costly and not necessarily more beneficial products.

Moreover, if you step back, IT is no new sheriff that just rode into town to save the day. EMRs have been around for a good two decades (Epic Corporation, which produces one of the most popular EMR systems, was founded in 1979). The VA hospital system has digitized health data since the 80's, and their VistA system became the largest in the country by 2001.

The point is, the movement for digitizing health information is not as new as the recent spotlight would suggest. It's been a (painfully slowly) growing process. Obstacles abound at multiplate levels when hospitals or physician groups are trying to decide whether to take the plunge into a digitized system -- internal politics, upfront cost of implementation, uncertainty outcome of better care or lowered cost, lack of convincing research, etc. The $19 billion provisioned in Obama's recovery package should help with the financial aspect, but it depends on the logistics of how and to whom this money will be dispursed. We need to see this money as a chance to radically shake up health IT, both in terms of widespread digitization and strategic change.