Current electronic health-care systems are built as monoliths. They are constructed and sold as all-in-one solutions, largely because of the failure of care provider organizations to successfully manage collections of smaller, more specialized systems. This failure is caused by two factors:
- The failure of the smaller vendors to cooperate and produce simple methods of supporting each other’s need for interconnection
- The failure of IT departments at health-care institutions to actively seek out and support such best-of-breed solutions
Since the specifications are designed by the IT departments, and the negotiations with the vendors are also done by the IT department, the ultimate choice of system will be something that is primarily intended to keep the IT department budget within bounds. If that involves having less functionality for the ultimate users, that is not something the IT department is aware of. It also has no incentive to find out.
What appears to us as a problem of closed interfaces is then rooted in a deeper problem, namely that closed interfaces is exactly what the current IT departments wish for. First and foremost, they do not wish to have any open feature that enables the medical departments to ask for, and possibly get, the smaller best-of-breed systems they need for clinical care, since it would often involve committing more resources for IT configuration and support.
Ultimately, this is a problem of priorities. Currently, savings of IT department resources are clearly prioritized above the needs for better IT support on the floor. I find it very hard to believe that the savings achieved in the IT departments of our health-care institutions, if any, is anywhere near the cost to health-care in the form of delayed diagnoses, increased pain and suffering, and increased insurance costs. As long as the authorities let IT departments scrimp on medical IT support by specifying solutions that inhibits any attempts at improving health-care IT beyond what the all-in-one vendor deigns to produce, we will not be able to improve health-care by better IT use. This is basically a political problem.