Health IT Has A Facebook Problem

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  • 05/18/2012
 The Facebook IPO was today's biggest spectator sport.  It wasn't just speculation about how much higher above the launch price of the stock the new public company would generate.  Facebook is a phenomenon that has transformed how we connect faster and more profoundly than we could have imagined even 5 years ago.  Though Facebook has changed the way we use the Web and share information, it is being reshaped more quickly by a massive global shift to mobile technology.  As a Forbes report observes today.  more than 50% of FB use is on mobile devices such as smartphones and tablets.   FB has not yet figured out how it can make money in a mobile and fractionated economy.  It has $10 billion of cash to figure it out but it is likely that FB will only be successful if it changes the way we buy and sell things we value with it's technology.  (As did Apple.)

If it ever needs a reminder of how to spend billions to accelerate it's uselessness, FB can take a look at the monumental waste of money devoted to health IT and it's various spawn -- electronic medical records, e-prescribing, clinical decsions tools,  and so on.   This is not the  most politically of correct statements.  Everyone LOVEs health IT and predicts that it can save billions in medical spending, improve patient care,  accelerate drug development,  make stir-fry...

Let's set aside that no one has taken a hard look at whether health IT has done any of this.  All we have are small, uncontrolled, observational studies that wind up proving health IT is 'transformational.'  Ironically, the same group of underachieving health policy 'experts' who push comparative effectiveness research, who claim that industry sponsored research is corrupt and that doctors who receive industry (i.e. evil drug companies) support are conflicted, have no problem with anecdote-based reports paid for by health IT firms or companies that get paid to promote health IT or using the findings to reinforce their faith in health IT.  And they have no problem with doctors getting health IT money or loans.   But I digress.  

The big problem with all the health IT hoopla is the fact that it's being lavished on technology and tools that are useless in a mobile environment.  And apps that merely ape enterprise-based systems such as health information exchanges don't count.  Those are about to become as outdated as typewriters and TVs with antennas or PCs for that matter.  In my opinion, they already are.   A big share of the blame goes to the establishment of the government health IT gravy train.  The morass of standards, accreditation criteria, meaningful criteria, silly interoperability standards (requiring everyone to share clinical data the same way everywhere) have guaranteed that anything launched in the past five years or in the future, will be (or is) obsolete.  Two quick examples,  government sponsored health IT never anticipated integrating genomic information and clinical data.  It never anticipated that both types of information could be generated, shared and stored by consumers themseves on something called a cloud.   

One health IT veteran told me in exasperation that if the government had tried to standardize the 'meaningful' use of the internet we would be stuck with Mozilla.  There would be  no other browsers (what a quaint term!).  Imagine if every company had to buy and sell products using the same accredited criteria, methods and interface.   There would be no Amazon, eBay, Netflix, you name it.   

Hence, health IT has a very big Facebook problem.   The good news is that most people (meaning consumers) find electronic medical records, most health apps and other mobile health devices as boring, confusing and pretty much useless.  There are dozens of companies promising their health info tools will reduce medical errors, improve patient outcomes, etc.   But few of them make medical care or staying healthy simpler.    The fact that we have to pay doctors to use health IT should tell  you about it's capacity to provide that benefit.   Did we have to pay physicians to use antibiotics instead of iron lung machines to treat TB?   No one is paying health professionals to use iPads.  Bribing and forcing doctors to use e-prescribing tells you something about whether most systems are really making prescribing safer and easier.   Morever, the vast majority of doctors block out drug interaction alerts in e-prescribing systems for one very good reason: they slow down prescribing and never take into account benefits and risks of a treatment for specific patients.   

BJ Fogg, a leader in figuring out how to get people to do things (which is really 90 percent of health care)  observed:

"There are two paths to increasing ability. You can train people, giving them more skills, more ability to do the target behavior. That’s the hard path. Don’t take this route unless you really must. Training people is hard work, and most people resist learning new things. That’s just how we are as humans: lazy.

The better path is to make the target behavior easier to do. I call this Simplicity. In my Behavior Model I sometimes replace Ability with Simplicity. I hope this isn’t confusing. Ability is the correct general term in the model, but in practice Simplicity is what persuasion designers should seek. By focusing on Simplicity of the target behavior you increase Ability."

Facebook is seeking to find a way to make connecting, communicating and consuming, simpler.  in the main BigHealth IT,  which was conceived by technologists coming off a bad acid trip,  has never given a rip about simplicity or ability.   It's all been about the government money, not us.   

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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