Is it Meaningful Yet?

12 year old James sits in his bedroom in Ann Arbor Michigan on a cool spring day in 1924. He has been feeling a little “under the weather” over the last two days and his mother is worried he might be coming down with a cold. However rather than having to bring him to the doctor’s office, today the family’s new “Radio Doctor” will see the boy in his own bed, in his own home under the watchful eye of loving mother, teasing brother and at the direction of his caring Dr. McMorris at the University. The “Radio Doctor” machine is a new innovation that James’ father, an electronics and radio experimenter, has developed to extend the reach of personalized medical care right into the home. The machine provides a two way voice and video communication as well as allows the physician to listen to Jame’s heart and even shine a light in his through to make sure his tonsils are not enlarged. The exam is completed in 15 minutes and prescriptions will be delivered to the home.

Of course the fantasy above never occurred, but the image was actually drawn and published over 85 years ago. In America today we are discussing the achievement of introduction of the latest information technology in support of better, less costly healthcare. We are attempting to move information on our very mobile American public through Health Information Exchanges (HIEs) to and from certified Electronic Health Records (EHRs) and seeking to define the Meaningful Use of information technology for the purposes of financially incentivizing (and soon after penalizing stragglers) the adoption of this new technology. To a large measure, the American Medical establishment is poorly prepared for this transition, yet major medical organizations are endeavoring to play “catch up” rapidly in pursuit of both the financial incentives for their membership and to remain current and relevant as the practice of medicine right and truly moves into the information age.

An early conundrum is recognized as the challenge to provide true interoperability of healthcare information technology (HIT) and more importantly healthcare information. Since the HIT industry has largely grown on the basis of market forces, competitive systems often integrate their technologies and information with some difficulty. Therefore some have already suggested that, in addition to HIEs that the personal heath record (PHR) owned and operated will be the answer to this exchange of vital medication reconciliation data and provide the “glue” piece of a patient-centric information “cloud”.

Simultaneously however, the world is witnessing a technological revolution in information access. A quick scan of the the news will reveal the hand-held cellphone with wireless internet connectivity transformation of everything from classrooms in Rwanda to social networking. You have to look a bit harder, but today smartphone telehealth applications everything from virtual intensive care rounding to fetal heartbeat and maternal contraction pattern remote monitoring ( are available. Now as they are, these developments are marvelous. However, if you remember James in 1924, you can start to see how it’s vital that we understand that the patient  always was, and always will be the center of the delivery of healthcare, in America or anywhere else. In our desire to achieve the goal of introduction of past technologies, it could be easy for us to focus on the hospital, or the physician or the outpatient clinic only, and forget that core lesson as we try to automate.

If we really study that amazingly prescient vision of James in his bed with the “Radio Doctor” however, we’ll be more likely to achieve our goal of truly meaningful introduction of the best patient centered  technology in our country. We’ll have information centered around the core that really matters, the patient, and we’ll be able to provide that care in the best,  most convenient, low cost, safe and comfortable way possible for our patients. And isn’t that really the whole point of our technology is all about?

About William F. Bria, II, MD

Chief Medical Information Officer, Shriners Hospitals for Children; President and Co-Founder, Association of Medical Directors of Information Systems (AMDIS)

St. Petersburg, FL

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