The Coming Revolution in Healthcare Information Technology

John Cullinane,
Chairman of the Board, LiveData, Inc.
CIMIT Innovation Conference
November 6, 20006

I have always said that recognizing the obvious before anyone else makes you a visionary. In my case, it was treating software as a product because it seemed to me that if you could buy software that was available now, that worked, was documented, and cost one tenth of a customized system, that it had to be the way of the future.

I feel the same way about sensor based systems. Its era is coming and it’s going to cause a revolution in healthcare information technology. Actually, it’s already happening but I doubt that most hospital executives realize it or how profound it’s going to be. The good news is that it will improve all aspects of a hospital’s relationship with its patients to the benefit of all stakeholders, particularly, the patients. The challenge for hospital management will be to completely re-think how a hospital should function and what systems are needed to make it possible. It’s worthwhile to see how these IT eras flow from one to another because sensor based systems are not new. In fact, it’s where the technology has been headed ever since computers were first introduced. For example, in the batch era, programmers brought decks of IBM punched cards representing the program and data to a computer room and handed them to a computer operator, literally, through an opening in a wall. This was, horribly, inefficient. There had to be a better way.

This led to the on-line era which allowed programmers to do two major new things. One was to create programs on line, from so-called, dumb terminals, linked to a large mainframe computer which they shared with other programmers. This dramatically improved programmer efficiency. They were also able to create new, on line systems, which are the IT systems foundation of most hospitals, to this day. However, I refer to these as "static" database systems.

The personal computer era began when young guys such as Steve Jobs, and Steve Wozniak began to think, why should I have to share a computer from a dumb terminal? Why can’t I have my own computer, all to myself, all the time? Dan Bricklin helped immensely by creating his Visicalc spreadsheet for the Apple computer. However, while the PC was a good tool for analysis, many users also wanted to communicate with other computer users, share information, send emails etc.

The Internet era was the response. Schools such as MIT had long been doing pioneering work in networking computers and sharing information in a research environment supported by DARPA. Tim Berners- Lee created the web and the Internet burst on the scene so dramatically that Bill Gates had not even mentioned it in his best selling book on the future of computing. He had to quickly add an Internet chapter and then move Microsoft, fast while playing catch up in the Internet marketplace. The message here is that if Bill Gates can miss something as significant as the Internet, a mere mortal such as a hospital CEO can miss the sensor based revolution in healthcare IT.

Why real time sensor based systems will be so important is that will deliver on the promise of computers as a management tool VS being simply a data processing machine.

When it comes to problems, ask any CEO, surgeon, nurse, or pilot what they would dearly like to know and the answer would be "knowing there is a problem in time to take corrective action". However, it requires real time sensor based systems to provide this information. Your gas gage in your car is a perfect example. You don’t want to have to access some static database to determine how much gas you have, you want to know, now.

What’s analogous to the Internet era is that people have been working on such systems for a long time, including in healthcare, but they are now ready to burst on the IT scene as dramatically as the Internet did. Think of an air traffic control system and how easily it could be a model for a patient traffic control system. Such a system would allow a hospital to control a 360 degree relationship with its patients via real time or continuous contact, on a 7/24 basis, with all the attendant benefits.

If you wanted to see how an air traffic control system actually works you could visit the Volpe Transportation Center, in Cambridge, literally, within walking distance of CIMIT’s offices. If you did, you would see every airplane in the United States on a large screen being tracked via radar, from lift off to touch down, on a real time basis. At peak time, which is late afternoon, this means about 5,000 airplanes are being monitored, simultaneously. This information is provided to specialists at other FAA traffic management sites, such as Herndon, Virginia who also monitor weather conditions, nationwide, anticipate traffic problems, and advise pilots, accordingly. Since each plane has a unique identifier, or sensor they know where each airplane is, altitude, direction, speed etc. but also how to direct them to better, and safer, more efficient flight paths by both the FAA and the dispatchers from their respective airlines, in a coordinated way.

The hospital of the future will have a similar Patient Control Room with specialists tracking and monitoring its patients, inside and outside the hospital, on a 7/24 basis, in real time, in exactly the same way but, because of GPS, it will be a lot less expensive. The great benefit for all will be the "anticipation" of problems, before they become emergencies. The possibilities for innovation in all this are unlimited because this also includes the virtual hospital which means bringing the hospital to the patient via telemedicine and telementoring. Telemedicine is what you define it to be including something so simple, but very effective such as a telephone call. Telementoring, of course, is monitoring and mentoring less experienced surgeons around the world using the web. All this will have huge benefits for hospitals, clinicians, and most importantly, the patients, and those that pay for the services.

However, the real time sensor based era will come with a major challenge. It will require a transformation in hospital information technology thinking as radical as when organizations first went from punched cards to electronic computing. There is one, major potential impediment in that hospital IT departments have long been used to building and running what I call static database systems, whereas real time sensor based systems have always been the province of engineers who specialized in process control applications, and never the twain shall meet. In other words, neither understands the other’s problems.

However if hospital CEOs are aware of this, in advance, then they can cope with it and move to transform their hospitals from "static" hospitals to a real time sensor based hospitals in its broadest interpretation. Some hospitals are moving in this direction, already, as they merge their biomedical engineering groups with IT.

In the final analysis, healthcare is becoming a global business because the economics are driving it in this direction. In the future, patients will go anywhere in the world where the service is best, and the cost is least. CEOs of American hospitals can take advantage of this opportunity by recognizing before anyone else that sensor based systems are the way of the future. This includes a real time Patient Tracking and Control System.

If I were the CEO of an American hospital, I would be moving on this, fast, just as Bill Gates did with the Internet, because it’s a case of survival. If Indian hospitals can do operations for one quarter of the cost, in state of the art hospitals, they can also track their patients, in real time, anywhere in the world, using the web. It’s just a question of who recognizes this opportunity first and does something about it.

This is why CIMIT is so important. It provides a unique forum where ideas can be discussed, and, better still, where solutions are encouraged and facilitated by its partners such as The US Army Medical Corps. This, in itself, is a huge competitive advantage because there is much innovation to be done with all this including the integration of real time sensor based systems with existing static hospital systems. Some may say that this is too difficult, it can’t be done but that’s the fun of innovation, doing things that people say can’t be done.



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