New National Research Council Report on Health IT

The National Research Council just came out with a report on computers and health: Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, that outlines a grand vision of what's wrong with HIT and what to do about it.

Here are their 9 principles to guide the use of HIT:

1. Focus on improvements in care —technology is secondary.
2. Seek incremental gain from incremental effort.
3. Record available data so that today’s biomedical knowledge can be used to interpret the data to drive care, process improvement, and research.
4. Design for human and organizational factors so that social and institutional processes will not pose barriers to appropriately taking advantage of technology.
5. Support the cognitive functions of all caregivers, including health professionals, patients, and their families.
6. Architect information and workflow systems to accommodate disruptive change.
7. Archive data for subsequent re-interpretation, that is, in anticipation of future advances in biomedical knowledge that may change today’s interpretation of data and advances in computer science that may provide new ways of extracting meaningful and useful knowledge from existing data stores.
8. Seek and develop technologies that identify and eliminate ineffective work processes.
9. Seek and develop technologies that clarify the context of data.

This is an important and welcome report by an experienced and wise team led by Bill Stead of Vanderbilt. The emphasis on achieving clinical results rather than achieving technology is, of course, an old lesson. But it warrants repeating. It is better to install a small system that you know will make one thing better than a giant system that you hope will make everything better. Such small systems need to be designed with integration in mind. But, if the system demands a wholesale change in behavior or a radical investment of financial, intellectual and human capital, watch out!

Happily, there are some approaches already available that meet the 9 principles. The Vermedx® Diabetes Information System meets all of them. It does it by having a narrow scope (just laboratory management for adults with diabetes in primary care). And, I would add another principle that Vermedx meets:

10. Demand rigorous evaluation