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Healthcare technology systems: What's working and what's not

“[The] American healthcare system is broken,” Robert Pearl, M.D., executive director and CEO of The Permanente Medical Group, said at the mHealth + Telehealth World Congress conference in Boston, and that includes healthcare technology systems too, he said.

In order to not be totally pessimistic, Pearl, also the president and CEO of the Mid-Atlantic Permanente Medical Group, did also talk about what certain healthcare technologies are getting right. But the overall message was that some serious work needs to be done.

Mainly, Pearl said that the approach to designing healthcare technology systems need to change. Right now, people are just building technologies and having the patient or physician adapt to the technology. Instead, Pearl said healthcare technology systems need to be designed for the specific problem it’s trying to solve. Therefore, the problem – whether it’s chronic disease or physician workflow – needs to be understood and the technology built around it.

EHRs are one example of a technology that needs major improvements, Pearl said.

“[EHRs do] not improve the quality of healthcare,” he said. What’s needed is a comprehensive EHR where all the information about the patient — and Pearl means all — is presented to the doctor. This means gathering information from different sources and presenting it to the patient’s physician and this requires interoperability.

Until a comprehensive EHR is created, other technologies important in healthcare will not be fully realized. One example is data analytics, Pearl said. “Data analytics is powerful,” he said, and it requires a comprehensive EHR in order to be truly effective.

What Pearl does see becoming a success is the use of video. He predicts that 30% of what doctors do in the near future will be done via video. Why isn’t video being widely used throughout healthcare today? Because it isn’t covered by insurance and therefore is not reimbursed, Pearl said.

One technology that Pearl is uncertain about in healthcare is artificial intelligence (AI). To Pearl, there are two possible use cases for AI. One is visual recognition meaning the technology would look for patterns that would ultimately lead to a diagnosis. And the second is determining the outcomes of treatment.

However, if you ask Pearl what he thinks of some of the AI technologies already out there, like IBM’s Watson and Apple’s Siri, he’ll tell you, “I believe Siri is going to be better than Watson.”

Why? Because you have Siri – and your mobile device — with you all the time.

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Because it isn’t covered by insurance and therefore is not reimbursed, Pearl said.

Bingo. There are many complex reasons.  But the single most significant in the US healthcare system is that CMS sets the standard for what is billable, or not.  Commercial insurance pegs itself to what CMS does.  The doctor and hospital ultimately work for CMS because that is who determines whether they get paid or not.

Patients are just widgets in the process.  They are regarded by CMS and software developers as widgets in the process.

Who knows the most about a patient and the patient's health history?  Obviously the patient.  But EHR is not designed for patient input and access to the EHR.  Until the system is changed from the provider trying to meet CMS expectations to the provider focused on the patient, patient health will not improve.
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