Are EHRs sufficiently “Clinically” Driven?


I was inspired to write this after reading of this great article Engaging Clinicians in Clinical Content: Herding Cats or Piece of Cake? by Heather LESLIE, Sam HEARD, Sebastian GARDE, Ian MCNICOLL

The very first paragraph got me thinking about more questions, see extract below:

“…Many will agree that, to date, the process of EHR development has not been clinician focused…”

The most immediate question – Really? Aren’t clinicians engaged in all of the recent large national programs we see globally? So, what are of our smartest and senior clinicians, clinical informatics folks doing in some of large national programs – is there a leading / best practice when it comes down to clinician : clinical informatician: healthcare IT engineer?

Another related question that has troubled me for a while: How do we measure whether an EHR implementation is reliable and safe?

Callum Bir

Is there hope in making Semantic Interoperability make sense?

“Semantic Interoperability” is one of those term that has bugged me for perhaps the longest; and each year, I gain a new level of appreciation.

A decade ago, I recall giving a talk in Beijing China titled “semantic interoperability” to a large audience who did not speak English. This was one of those dual English/Chinese presentations. The night before the presentation, I was briefing my translator, and also a good friend as he was also an associate professor then at the local university in medicine. The first hardest task, was to adequately translate “semantic interoperability” title in Chinese. This was a really long-night discussing the context, the semantics, the so-what, etc. The next day, the presentation I thought was reasonably well received, at least because there were so many questions (all in Chinese) asked by the audience. As I recall, it took us a few years in China and really tested us on our own understanding, especially when the landscape was so different; everything from problems we were trying to solve (then), were not as well articulated, the lack of business-case, commercial environment, and overall, lacked approaches that worked [in China].

By mid 2000s, having completed a few complex / large implementation projects in Asia, I recall another major time, when I presenting project updates to my colleagues in the US at HQ. During the presentation of the details of one my large and more complex projects ( >$10M), one of my US colleague was steaming, and, resulted in him starting to “scream” at me and my team, because it wasn’t going to achieve “semantic interoperability” goals. Our initial reaction was, the client is really happy, we have signed off on the deliverables, it is meeting the client’s business goals, so, what’s the gap? Was this just a matter of semantics? This meeting ended abruptly, as he went out of the room, and everyone else in the room was left perplexed. It was time to ask “what is semantic interoperability“? I took my Singapore team aside, and asked them, if they knew new what went wrong. At the day progressed, we had spoken to a larger number of people in the same floor, while nobody understood the point. Through the week, further analysis, we learnt about the “levels” of semantic interoperability, and what are some implementation considerations. For the next 5 years after that incident, within the core Singapore colleagues would dare use the word semantic interoperability, and had become a sacred term, and we spent every extra effort in circumventing it.

On the other hand, in the past 5 or so years, I have seen a lot more people who use these 2 words fluently, especially from those where English isn’t their first language. It always sounds so much better when someone else trying to explain what it means, or, to sit in a room full of people who can appreciate the term.

Fortunately, there are now “standard” definitions of semantic interoperability, and also standards on the levels of interoperability, eg, level 0, 1, 2, 3 with intermediate grades.  One the definition I find interesting reading is Conceptual Interoperability (source: wikipedia) , which is level 6,

"...Level 6: Finally, if the conceptual model – i.e. the assumptions and constraints of the meaningful abstraction of reality – are aligned, the highest level of interoperability is reached: Conceptual Interoperability. This requires that conceptual models are documented based on engineering methods enabling their interpretation and evaluation by other engineers. In essence, this requires a “fully specified, but implementation independent model” as requested by Davis and Anderson; this is not simply text describing the conceptual idea." (Source Wikipedia)

Could this be the next key word for the next decade?


Healthcare IT Spend

Hospitals IT spend as a percentage of the operating budget or revenue can often be less than 1/4 spent by a bank or a telco. Looking at some of the private hospitals across Asia Pacific region, some of them spend are less than 1% of their annual revenue.

One of the key questions I spend time asking chief executives is, why is the IT budget so low?  This is probably also a reflection of the relatively low IT maturity in this sector especially in emerging markets in Asia.

There are many factors contributing to the relatively small spend.

Part of the problem I find is the lack of an open dialogue around the level of spend, and lack of strong business-cases that are presented to CFO and CEO.