DARPA for Healthcare: An EMR Shootout

Dale Sanders, CIO, National Health Services Authority, Cayman Islands

Building on a recent post about Peter Orszag’s resignation, and stimulus funding for healthcare IT…As long as we’re throwing money around by the billions…

If I were Dr. Blumenthal, I’d dangle $500M ala DARPA in front of Amazon, Google, Nintendo, Facebook, salesforce, eBay – or any other capable body – and sponsor a shoot out: Build an inpatient/outpatient EMR and financial management system that will rock our world.

In the rush to incentivize adoption and certification of EMRs, there is a commensurate rush to purchase known and “safe” products – the market leaders with typical solutions – and that will be a disaster. Many of the top EMR vendors themselves will tell you behind closed doors that they are not necessarily proud of their products, but they keep selling, so there is no incentive for them to stop producing.

The current HITECH focus on investment in integration is putting the cart before the horse….we need better horses, first. The measurable and sustainable value provided by HIEs is the reduction in redundant lab tests. That’s as far as we need to go with HIEs at the moment, and that’s a relatively simple technical solution that the insurance companies offered to providers many years ago, but providers rarely accept.

We are taking on massive federal debt to invest in a crop of mediocre products. Here’s the ironic scenario that I see: Five years from now, when almost everyone is running on EMR products designed around paper charts; and inflexible client-server, message oriented architectures, there will be a new and better product on the market, probably produced in another country, which is better than anything else on the US market … but no one in the US will have the money or willpower to adopt and adapt it for the US, because they exhausted themselves under the current HITECH strategy of Now, Now, Now. Let’s ensure and accelerate the development of that better product in the US and hold-back some funding to make its adoption possible.

We don’t need more medical informaticists. We need hardcore computer scientists and engineers, like the kind going to work for salesforce.com, Nintendo, Facebook, Amazon, and Google. It’s much faster for the supply chain of labor to teach great healthcare to a computer scientist, than it is to teach great computer science to a physician or nurse. No offense to my many doctor and nurse friends, most of whom would agree.

I’m not saying that we will receive no innovation from HITECH. I’m saying we won’t get as much innovation as we need or could, unless we set aside more funding and manage it properly to stimulate true innovation in healthcare IT.