Health IT: Just the start

It is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever.  It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman and child.  Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States Department of Health and Human Services, is finally, without further ado; the Federal Health IT Strategic Plan 2015 – 2020.

You think I am kidding.  A satirical dig at another monstrous, useless, governmental report?  Absolutely not.  The concepts outlined in this blueprint will transform healthcare.  It is a tight, clear, document, which at only 28 pages, delivers almost as much change per word as the Declaration of Independence.  This may be the most powerful application yet of computerized information technology.  If you want to know where healthcare and health IT are headed, The Plan is absolutely worth a read.

I have only one complaint; it is coated with too much sugar.  Restricted by policy structure and jargon, the report does not go far enough.


In brief, the Department of Health breaks down the coming years into five sets of IT goals:

1.            Achieve universal adoption of Health IT, which includes building confidence in these systems, improving the quality and quantity of software products, and creating a national infrastructure to support their use.

2.            Develop local, regional and national interoperability; connect all systems and devices.

3.            Improve medical care delivery by using IT to support quality, access, and  safety, in order to improve individual, community and population health.

4.            Empower individual, family and caregiver involvement in healthcare decisions and control by promoting IT access to records, decision tools and encouraging personal engagement.

5.            Through IT, increase the availability, usability, and dissemination of health-data for medical research and to accelerate the implementation of medical breakthroughs.

Health IT will connect everything and everywhere, from the chip in your pacemaker, the scale in your bathroom, your Smartphone Health App, your first tetanus shot, all the way to the machine pumping air in the intensive care unit on your dying day.  Medical records will be universally accessible.  IT driven research will spot trends, respond to individual and population emergencies, and promote ideal health. We will each have improved control of our medical care with an emphasis on patient safety, quality, and cost, while trying to guarantee privacy.


This is remarkable, powerful stuff, promising great improvements in health. However, when all is said and done, the report has a major flaw.  It does not make the truth clear:

Health IT will completely change what it means to be a patient, a hospital, a health system and, above all else, what it means to be a doctor.

Three powerful forces will force health IT to radically transform medicine.  The first is the rapid revolution in the capabilities of computer systems.  As not only speed and size increase, but also the ability to “compute,” in other words “think”, we will rely more on software intelligence to actually make decisions, not just file and communicate.

Second, the volume of published medical research will continue to expand logarithmically.  It is impossible for any doctor to be “state-of-the-art.”  Even experts in very narrow fields, fall rapidly behind.  In 2015, every medical student on the day they graduate will say, “I am hopelessly out-of-date.”

Finally, the introduction of genomic or Personalized Medicine will require data demands in the care of each patient beyond human capability to comprehend.  Medical care based on the millions of choices in each individual patient’s genetic code, will require thousands of decisions for each patient in the course of their life; no doctor will be able to understand, assimilate and apply such complexity during the course of a 10 minute office visit.

These three futures, expansion in computer intelligence, an insurmountable amount of medical knowledge, and the nearly infinite complexity of practicing health care based on the genetic code, mean that being a doctor or a patient will radically transform.  The doctor will no longer be the final fountain of health knowledge.  The doctor will no longer propose or possibly even make diagnoses.  The doctor will no longer design or recommend treatment.  For all of these functions, for which we turn to the physician today, we will turn to the Health IT computer.

What will the doctor do?  Serve as health manager as well as an input and output device; the vital link between silicon software and carbon wetware. The physician’s role will include not only understanding human beings, but also advanced computer systems.

Doctors will examine the patient, and perform physical functions, such as certain surgeries and procedures, not easily mechanized.  Doctors will listen, teach and guide patients and families.  They will provide flexibility when disease and patient do not comply with protocols and rules, such as when a diabetic patient with multiple injuries from a car accident has a heart attack and refuses care.  Physicians will give social, personal, and emotional support during those horrible times of life when patients are challenged and racked by disease; they will still be that knowing hand on the shoulder at the bedside.

The more computers are in charge of data and diagnosis, the more closely these systems will need to be watched.  The potential for glitches in programming to cause harm will be very real, as will the need to “humanize” objective data driven decisions, so that the best IT derived quality recommendations can be applied to real people. Physicians will need to be experts in complex information technology, with a master’s understanding of the strengths and limits of artificial intelligence, just as they have an understanding of human intelligence.  As medical schools teach pharmacy, pathology and psychiatry, so they will teach medical informatics.

In turn, patients will obtain much of their medical care without ever seeing a doctor, nurse practitioner and physician’s assistant.  Why wait sitting on a hard clinic chair, squirming with a urinary tract infection, if all you need is a culture and an antibiotic? Your Ipad or tablet can do that.  Why drive your kid with an earache to the pediatrician, when a device attached to your phone that can take and analyze a picture of the infected drum?  Leave work to get your blood pressure medication refilled?  Take a chance that your doctor makes a mistake, forgets a test, or prescribes a drug to which you are allergic, when you can get answers and treatment from your laptop?

The Federal IT Plan shows us the next vital steps in the revolution sweeping across healthcare. More than any advance in cancer care, cardiology, immunology or infectious disease, these steps lead to a different world.  Will such a world provide better care, with improved results, decreased complications, higher functionality, greater privacy and longer survival?  Undoubtedly.  Will the metrics show improved quality?  Without a doubt.

Will it be a gentle world, a compassionate world, a human world?  That is for the future and each of us to decide.


  • There seems a prevalent fiction that involving family members in one's health is a good idea. Family members have been the source of interference, misinformation, unwelcome and unwise control and just plain meanness. Yet the medical community supports the government in providing these relatives access to our records? We patients already have enough problems. Those intake forms should ask: is anyone interfering with your medical decisions?
    • meyati
      My son is a disabled vet, 150%-a combination of injuries from a maritime accident. Why in the world should he be bothered because I won't fast for a test. Why should he be bothered because I'm fighting Medicare and the Advantage plan HMO whether I have the right to get a prescription and pay for Armour thyroid. I get bad side-effects from synthetics. Aunt Gladys had 2 pacemakers, several surgeries to each knee for artificial knees. She was in her 80s. Her news and heart were going out again. We visited her, and she asked if she refused medical care, would that be suicide. I told her about a DNR-and legally the doctor had to do it. The doctor had wanted her to have one, but her religion. Let me put it this way-she called and she and her happy doctor made out a DNR. Months later, my husband got a phone call, and he was told that I murdered Aunt Gladys. So families can interfere with medical care, and frail family members don't need that stress. My son knows that I have these problems with doctors. I don't go on about it.
  • meyati
    Who will order the labs for that urinary infection? In 2013, I had strep for 5 months, because I couldn't get somebody to use a cotton swab. My EMR lists that I was high maintenance because I spent so much time in Urgent Care clinics, ERs, and at my PCP. I went to another doctor and complained that I had strep. He started the lecture about dry mouth. I screamed, and he looked at me. I spit a big goober in my hand and shoved it in his face. I left with a positive strep test and a prescription of Augmentin. I taught computer tech at a high school. I like to use Adobe for old fashioned graphics, I don't care how fancy a program is, it's the human factor that makes it work, and how effective it is. First, how is the software written and how does the clinic-insurance-Medicare-HMO implement the software? Next, will a doctor properly use the software, or blame all of their problems, lousy regs, difficult patients, Medicare restrictions on meds and care, an unhappy marriage, their own bad health on the software? Would this genome program help a hypothyroid patient that's allergic to synthetic thyroids get their Armour-or would I get more letters from Medicare telling me that I'm not in compliance with Medicare regulations. I have 3 weeks to start using a synthetic thyroid, and any physician that prescribes Armour will be in trouble. I actually received letters like that from the Medicare Pharmaceutical Formulary Board, and my Medicare advantage board. It's like the French revolutionary council that decided in a matter of weeks that all French families would speak French. In today's French provinces, families and businesses still speak german, Norman, Breton, and share an ancient Celtic language with a Spanish region, the Welsh, and Irish. Then you have the patient. Doctors don't listen to me that I need Armour thyroid, that I throw up a lot if I have to fast-so live with it- they won't, so I refuse fasting tests. I'm tired of arguing about that. All it does is to raise my BP. You know that a non-fasting test result creates false high levels of glucose and cholesterol. This summer a lab decided to change non-fasting to fasting-probably to meet some Medicare or NIH standard in the war against me. I have statin toxicity because of this war. It was for prevention. I was tired of being nagged. That's the human factor-a doctor that was trained and pressured to get people on a statin. The level was low. I thought that I might get a rash, throw up, Nobody told me that I'd pee black, my feet and ankles could swell up, my Achilles tendons would go, that I'd spend months in physical therapy, so I could walk a little. That I'd have seizures. I kept telling them that nobody in my large family had any heart problems. They told me that I was a liar. One grandpa was drunk and got run over on his 98th birthday. Another one was on a hunting accident, while crossing a fence- 96 years old and he used a scythe to cut down neighbors' weeds. One Grandma slipped on a fresh waxed floor during a blizzard, she perished slowly and painfully-98, the other grandma was 102 and was in a car wreck-she was a passenger. The young ones died in places like the Pacific, Normandy, Korea, 'Nam, No, I won't and don't cooperate. What good have they done for me? I fight for the right to get a script and pay for my thyroid, a whole 31 cents a day. I refuse to lie down and die from the lack of thyroid supplements. I've tried to take synthetics twice. I really, really did, but I refuse to die so we can meet new standards. I don't want any new wars, goals, standards. if I get strep, an earache, sprain an ankle, or bit by a dog, I want to be cared for. I have a right to get a script for my Armour and to purchase it myself.
  • Liz
    Umm yeah. Brave new world. Everything is on computer. Sony got hacked. The pentagon got hacked. Obama's phone got hacked… Identity theft via medical records is on the rise - and that is before Big Brother. Little to no screening who has access to some or enough of our medical records to steal our identity as just about any employee does. I have spent 3 YEARS trying to get corrections in my medical records at MD Anderson Cancer Center. These are important mistakes that matter. There is a significant down side to universal access to everyone's medical records nation wide. Actually there are significant issues even if access is only one facility. On the one hand I agree there can be some good done. On the other hand there are risks involved, human error… and quite frankly while self directed medical care that cuts medical professionals out of the loop has its appeal - eg I have a UTI so give me an antibiotic with no human intervention might work if a patient was educated enough, personally I want human intervention. That UTI that I just mentioned… well it is the human medical professional at urgent care who caught that I was also passing a small kidney stone when I had that bright red blood in my urine along with all the symptoms of an UTI this last thanksgiving day.
    • meyati
      Like I said-How will we get that diagnosis and prescription without a human. In my opinion you were lucky that the human paid attention to you. Trying to correct an EMR is almost impossible. Because of privacy nobody but my doctors can see my DNR or anything else that counts. That's so wrong-hospitals will do anything and use any excuse to keep you alive. They should be denied payment-unable to sue the patient or family if they resuscitate a patient with a DNR
  • D Someya Reed
    Recently you showed great disfavor for those patients who use the Internet and self-diagnose. This is nothing compared to your promotion of Artificial Intelligence (AI) that will make physicians largely unnecessary as patients will use the Internet to diagnose "minor" ailments and access results & recommendations for more complex ones as provided by thinking machines. If the data stores, as you say, will be incomprehensible to humans then we will have little choice but to comply if we want to continue to receive care. Although, I don't know who is going to do the initial programming with information we can't even hope to understand. Let's take this out to its logical conclusion. How will you feel, retired or not, when the medical field is fully replaced? Self-teaching, self-upgrading, self-repairing (self aware) machines with 3-D printers or better will replace all. Doctors won't be learning or mastering complex information technology...the machines will already know that and always out-pace them. Besides, if doctors wanted to be in IT they wouldn't have studied medicine. AI will have no problem mastering surgical skills if mere humans can learn them. Even low-skilled positions (such as data entry) will no longer be needed...your AI doctor will record all necessary information "live." How will you feel when your own AI doctor does a checkup on you and determines the cost to benefit ratio of your treatment just doesn't pan out? Or do you really believe that the intent of all this is with the best interests in mind for every individual "Jane and John Doe and their kidlets," irrespective of cost? There has been no pretense of the fact that this data collection is for cost savings and overall policy making. Improved healthcare is nothing more than an expected by-product. Funny how there are incentives for the medical industry to sign up and fines for those who don't make the expected progress toward goals. Why the rush? In a truly patient centered environment wouldn't any progress be considered a positive and not deserving of punishment? So now patients will be responsible for fully understanding their own care and held accountable (another reason for this plan) should their care fail (they knew all the risks) or for their failure to do as instructed (phrased as a "recommendation") by their AI doctor. No lawyer will have a case as your AI doctor won't be determined to be "a person" worthy of litigation anytime soon. I suppose, on the plus side, malpractice insurance will go away. However, the disclaimer patients will need to sign in order to receive care will be massive and ominous. I'm sure an industry will arise in helping us navigate this document, though. Are the AI fears expressed by the Stephen Hawkings and Elon Musks of the world to be ignored as fear-mongering? If we can't even control another person, how can we hope to control AI that outstrips us in every way? I guess there's Isaac Asimov's "Three Laws of Robotics" to fall back upon. Hope the programmers don't put in a "backdoor" to be exploited. They certainly won't be saying you can keep your doctor this time.
  • This sounds very much like a tongue-in-cheek analysis. I hope so. I will download the report and read it, though. Thanks.

Leave a Reply