By testing out new knowledge in clinical practice, we provided a feedback loop, which continually advanced the Science of Medicine. In order to aggregate data from across the nation or globe, and to achieve all these incredible benefits, it dawns on us that we need to have a standardized, highly granular, medical vocabulary, coding and audio transcription system. So we develop one.It also becomes crystal clear that we can dramatically enhance the triage process as a direct byproduct of the patient-history activity. By simply having patients document their symptoms, prior to any clinical encounter, at a community kiosk or over the Internet, this extremely comprehensive, structured/codified history is available for application against a powerful and ever-improving triage protocol. The intelligence of this approach becomes so obvious that dedicated physicians start begging that the documentation of their physical examination also be entered in a structured/codified format. (Don’t laugh. I haven’t woken up yet.) They recognize around the same time that it becomes evident to the managed care organizations that, even if encounters took a little longer, the improved effectiveness in diagnosis, problem management, and health maintenance would lead to a decreased requirement for healthcare, thereby resulting in lower cost and higher profit. Not to mention happier customers. And the encounters actually took less time, because patients did much of the time-consuming work themselves. While some physicians scheduled additional patients each day, most preferred to spend more quality time with each patient. Both patients and physicians live longer.Less need for care, more efficient care, and better care bring about unprecedented improvements in the overall physical, mental, and social well being of the entire population of our planet. I wake up with a big, healthy smile on my face.I have a nightmare.
In this nightmare, this horrifying nightmare, we continue on our present course of CPR design. We provide systems that reflect just what the users, primarily the physicians, want. We state, with a tremendous sense of confidence, that we are not simply putting the paper record on a computer. But that is essentially what we do. Because physicians are like everyone else: they love innovation, hate change. Yes, we do provide instant, simultaneous access to patient data. And we incorporate graphical user interfaces and elegant links to various information systems. We save operational expenses related to managing the paper record. But the process of care hardly changes at all. Physicians dictate more and handwrite less, improving legibility. But they are still free to elicit and document whatever data their unaided minds tell them to. No help from the computer. The more enlightened sites do stick in some alerts and reminders. But we blow the opportunity to really make a difference. The physicians are gleeful that they have not had to change their behavior to meet the needs of a computer program. As Larry Weed has said, “If physicians were in charge of airports, there would be no radar.just intensive care units all around the periphery.” The cost of care substantially increases since these CPRs are so damn expensive and the quality of care gets just a little bit better. Eventually, we realize our mistake, and move to change it. But by that time, both you and I are dead, due to delayed diagnosis and ineffective treatment which would have been prevented if the good dream was in effect.
The Art of Medicine, however, is safe. I wake up screaming.When HIMSS asked me to be guest editor for this issue, I jumped at the offer. I figured that this was my chance to maximize the probability that my dream and not my nightmare would be in our foreseeable future. I agreed to assume this honorable position only if the issue’s theme went something like, “CPRs that actually improve healthcare”. HIMSS concluded that this would be a rather interesting topic for its readers.So I selected as authors the 10 people whose work in this area most resonates with my soul. They often reflect an entirely different perspective than I do, but they consistently apply intensive open-mindedness to the accomplishment of the same ultimate goal. All 10 turned out to be physicians. But I proceeded anyway. That is the etiology of this issue of Healthcare Information Management.I will let their enlightening papers speak for themselves. However, I am sure that I speak for all of the authors when I say that we fervently hope that contributing these works helps at least a little bit to guide CPR development and implementation in the “right” direction. Of course, we could all 11 of us be dead wrong. Conceivably, maintaining something much closer to the status quo and simply providing better access to data might be the best way to go. You see, the key to this whole adventure is outcomes. There may be no more important early step than to determine how to measure the quality, cost, and health status outcomes. This is not an easy challenge, but it must be taken on.