I appreciated the message of Carol Diamond and Clay Shirky’s recent piece in the August 2008 Health Affairs titled “Health Information Technology: A Few Years of Magical Thinking?” In it they say that “proponents of health IT must resist “magical thinking,” such as the notion that isolated work on technology will transform our broken system.” It’s interesting to think about systems change at the front end, and how easy it is to get stars in our eyes about how things like health IT or personalized medicine will transform the world as we know it, and how all of our problems will then magically go away.
The article discusses how it might be easier to implement IT in health if the whole system is redone, rather than bolting on IT. IT will not fix the problems without key changes in how medicine is practiced.
A press release discusses some of their points.
Diamond and Shirky propose an alternative route to using health IT to help transform the U.S. health system. “This alternative approach would focus on a minimal set of standards at first,” they say, and would make utility for the user and improved health outcomes, rather than vendor agreement, the key criteria.
Diamond and Shirky’s alternative approach “would mean working simultaneously on removing other obstacles while concentrating on those standards necessary for sharing the information, however formatted in the short term, to flow between willing and authorized participants. Finally, it would require clear policy statements that will guide the design of technology.”
Sounds like a bottom up approach with the end user driving the technology, rather than health vendors. More from Margaret Anderson:
Cell phones, email, and the Internet have certainly transformed things in ways we couldn’t have imagined, but they’ve introduced problems we couldn’t have imagined. Technologies such as FAX machines have been leapfrogged over. Problems such as the overabundance of information, and the speed of information flow are here to stay it seems. In the case of health IT, FasterCures sees it as a vital bridge to the future of more rapid information collection, characterization, and analysis which could speed our time to cures.
But there needs to be careful attention to the fact that too much information, particularly in the health field, can make it much harder to make accurate decision. eventually we will get the complexity of the system under control but in the meantime, there will be some problems. Faster Cures is examining them.
We are working on a white paper for the U.S. Department of Health and Human Services about educating and building awareness among consumers about personalized healthcare. This is another area where we must resist “magical thinking” and get down to brass tacks. Too often, the discussion about personalized medicine has been at a 30,000 foot level. For this paper, we’ve talked to many patient advocacy and disease research groups and everyone holds their breath about the potential power that these technologies may hold for their disease areas. They all want more targeted therapies with fewer side effects, which is ultimately the promise of personalized medicine. But they also recognize its complexities. It needs to take into account the world of co-morbidities we all live in; even if baby boomers are out running marathons and eating their greens and blueberries, the reality is that many of us are living with many conditions and diseases, not just one. It will probably raise costs before it can lower them. It’s unlikely many diseases will yield to the relatively easy HER2-Herceptin gene-to-drug relationship. Patients are likely to get much more information about their genetic makeup than they can act on in the near-term.
Health care is still too complex in most cases. The real magical thinking comes in the form of so many fraudulent ‘cures’ that have plagued mankind for thousands of years. Perhaps as we really get IT involved in health, we can begin to gain a fuller understanding of what causes disease and how to attempt a cure.