Jaana Sinipuro’s Post

I fundamentally disagree. One counterpoint: One of the most successful hospital systems in the world, Mayo Clinic, was also one of the first to create an "integrative medical record", a document which as the name suggests is used to "integrate" health information from different sources. Mayo now uses Epic, and they find that doctors rate EHRs below Excel in terms of usability. I agree with your first point about paper. Here's where I think our disagreement comes from: You see and outline this as incremental forward development. Paper -> EHR -> Etc. In reality (if I may be so bold), Paper -> EHR only encapsulated a small portion of the medical reality. Electronic Health Records do not comprise All Records Used In Heathcare. We are STILL living with paper in many domains of medicine, such as morgues. Bodies are lost or misplaced, tallies are inaccurate, and so forth, to give one raindrop in the ocean of missing information. I do agree that the future is a unified platform. But that platform will not be a progression of EHRs, it start as a reinvention of the paper we started with.

Let me add more meat to my disagreement: Given "Paper stage" (as listed in the PDF) captured a limited scope of medicine, resulting in point solutions, and given EHRs simply added modern ERP features on top, the latter 2 parts are doomed to fail as they're building on a broken foundation. What we need is to understand information. A radical reimagining of what digital health systems ought and must do. I've seen Vince Kuraitis write well about it, so I'm a little surprised by the lack of consideration on the "semantic gap". Unified platforms cannot bridge this gap by building bridges over it. Let me attempt to demonstrate my point: Given datapoints 1...40 ranging from "mother had breast cancer" to "the patient had bouts of diarrhea recently" captured in Medical Records A...B, C...D and E...F is fragmented in the EHR[1] are neutral in their semantic value before the doctor forms a basis for differential diagnosis[2], it's impossible to set a semantic or hierarchical value to this datapoint at the time it is recorded. Instead, the same information must also be entered again and again during the patient's care workflow. First you do a family history at the GP or initial appointment, then you're referred to a specialist who notes this datapoint as useful, and enters it into their EHR again, and so on. For some datapoints such as differential diagnosis using radiological and pharmacological evidence, this effort can span weeks or months and dozens of interactions. Sometimes the information is used over decades. To say this is "fragmented" is to do a disservice. It is unacceptable. We must understand that information has a time dimension. And that doctors must be given the ability to check old information, and to "point to it" when it becomes pertinent to the patient's condition. Instead, the modern health ecosystem is built from the ground-up to frustrate the use of information contained within it. Unified platforms will exist. But they will come from surprising places. Perhaps they will start out as EHRs. [1] the same information may have to be entered in multiple formats for different uses; medical record A1 and C1 may be identical except for one datapoint, and they're separate categories because A...B is radio-oncology while C...D is general practice-cardiology (these examples are frivolous for the purpose of illustration) [2] (mother's breast cancer is relevant for women with specific symptoms, but not men; diarrhea is irrelevant if the patient has a sprain, etc),

“𝐀 𝟑𝟎-𝐘𝐞𝐚𝐫 𝐅𝐫𝐚𝐦𝐞𝐰𝐨𝐫𝐤 𝐟𝐨𝐫 𝐏𝐥𝐚𝐭𝐟𝐨𝐫𝐦𝐢𝐧𝐠 𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞, 𝐯𝟐.𝟎” -- that's the title of the the .pdf below. This is my attempt to explain how healthcare inevitably will be platformed. Please take a look at this 15-slide capsulization. You can download it as well. The phasing, in a nutshell: Before 2008: (Mostly) Paper Point Solutions Early Digital Health Platform Unified Digital Health Platforms Megaplatforms (and super-apps?) 𝐂𝐨𝐦𝐦𝐞𝐧𝐭𝐬/𝐝𝐢𝐬𝐚𝐠𝐫𝐞𝐞𝐦𝐞𝐧𝐭𝐬 𝐰𝐞𝐥𝐜𝐨𝐦𝐞𝐝! #platforms #platformstrategy #digitalhealth The Fast Future Executive

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