In today's world of Health Care Informatics nothing seems more vital than creating and implementing “The Cloud". This synthesis of all things digital that can transform data from any system and transport it to any other system in an accurate, usable format is intended to be the focal point of Health Information Exchange. Because of the HITECH Act and the subsequent health care push to divest itself of paper and go fully electronic many multinational companies see a tremendous new business opportunity in health care. Microsoft and IBM immediately come to mind but others like Google, AT&T and Verizon have quickly followed. This evolution makes sense because these are the companies at the forefront of making communications and information transfer easy and always accessible for the masses. So what is their role in developing “The Cloud” and why do we need to progress into something much more comprehensive yet uncomplicated for the end user?
The theory behind the Cloud is that it can (or will be able to) accept electronic information from unlimited systems, hold the information in storage and when called upon, instantly and accurately deliver it to either the originator or a completely different system. The goal is to speed the acceptance of an electronic health care age by making all systems fully interoperable regardless of structure and design. In order to do this the programmers must break each component of the health care process down to its essence. A lab panel will not be sent to the Cloud as 25 interlocked pieces of information on a form or template that has to be retrieved in this exact same format in order for the information to be readable and accurate. Instead the 25 lab values will be formatted individually so that the value for red blood cell count will be separate and distinct from the value for white blood cell count. This will allow the receiver of the information to choose to see only 1 value from that panel of tests or to see any combination of values. The report the receiver sees can now be configured into any format that meets his or her needs. The companies mentioned above and countless others are dedicating billions (more?) of dollars towards the resources needed to accomplish this task. Creating and implementing these Clouds will go a long way towards advancing the acceptance and use of Electronic Health Records. However this still does not address the heart of the problem for the end user of the EHR.
The electronic consumerism brought to us by Microsoft, AT&T and others builds on our individual likes, needs and wants of how we will use the products. Complete customization endearing us to ease of use and inherent familiarity are becoming the norm. We have individual cell phone rings, point of sale devices that easily recognizes keypad number input or your signature, voice recognition software and even a GPS that combines coordinates with real time traffic information and gives you directions in whatever language you choose. Now with genetics, health care is starting to provide individualized health screening and drug therapy. Talk about customization to what works for each individual!!! This is what is missing in the current EHRs that would facilitate adoption more than anything else.
Early scientists and businessmen like Thomas Edison, Nikola Tesla and Napoleon Hill spoke and wrote often about a “universal connecting substance or energy” called Ether. Per these great minds, Ether permeated everything and directed energy including electrical current, and even thought waves from a sender to a particular receiver. This abstract notion of Ether was used to explain events such as how Egyptians and Mayans, while continents apart, could assimilate diverse groupings of information into intelligent data/facts and build almost identical pyramid temples that functioned as calendars and repositories of mathematical formulas. I believe the large corporations are missing their chance to innovate what they are learning while constructing “The Cloud” into a seamlessly customizable integrated EHR system that could become “The Ether”.
Once they have mapped each item or process of health care so precisely that it can be separated from an existing panel of data, stored as an individual piece of information and later retrieved by any system in an accurate, useful manor then they can develop this into the ultimately customizable EHR. With all of the components of health care electronically regimented and organized in such a way then surely a copy and paste system could be utilized to build the “perfect” EHR. Since the information could be easily stored and retrieved by any system configuration the screens of physician partners and their staff could look completely different. Building on existing technology it would be up to the user if they typed, wrote, spoke or used any of these in combination to input the data. The Laboratory file tab could be on the left of the page for one user and the bottom right for another. Each user could build their own diagnostic imaging or lab test panels for what was most important to them and it not hinder how another provider could view that information at a later time.
Primary barriers to EHR adoption by the people trying to use the systems are the lack of familiarity and insufficient ease of use. Current societal conditioning exacerbates this because so many other things in our lives have evolved to becoming almost fully customizable. While building “The Cloud” the Multinational companies need to be looking to the next great improvement. This moves us away from choosing a system that is acceptable for most of the people involved to each person essentially creating his or her own system. “The Ether” could be the design that fully integrates the end user with the Electronic Health Record.
