Health Informatics in the Cloud

by Mark L. Braunstein

Despite its high cost, the US healthcare system produces relatively short life spans, and is wasteful, inefficient and has serious safety and quality issues.  While other industries have surmounted similar challenges by transforming themselves through information technology, healthcare lags behind.  Major reasons are that our approaches to care delivery and financial incentives were designed for a bygone era.  Beyond that the technology offered to practitioners has often been overly expensive, poorly designed, overly proprietary, hard to implement and difficult to use.  Spurred by a unique, one-time Federal stimulus and the new mobile, wireless and cloud technologies now available, this landscape is rapidly changing.  To succeed going forward practitioners, and those interested in entering the field, need to understand the new driving forces and have a basic understanding of contemporary clinical informatics. Practitioners, in particular, need to understand the alternative technologies and approaches available for their use in individual patient care and more continuous management of their chronic disease patients. To efficiently meet these needs, this book provides an introduction to the rationale for care transformation through clinical informatics; its application to patient care outside of hospitals; and a look at its future.  Key points are illustrated throughout by actual examples of open source and commercial health IT products and services. While written with practitioners and students entering the field of clinical informatics in mind, the book eschews technical terminology and is easily accessible by the lay reader not proficient in clinical medicine or information technology.

Genres: Health Care

114 pages, Paperback

First published October 16, 2012

About the author

I've been involved with health informatics since well before it was recognized as a useful field! Yes, that goes back to gigantic computers with virtually no horsepower or memory by today's standards. For example, my early work on an electronic medical record was on a DEC PDP-15 'mini computer' (actually quite large) with 64,000 bytes of main (core) memory and twin 30 MB hard drives!

Nevertheless, those of us in the field actually did useful work back then as I try to explain in my latest book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare. It is intended to be a broad introduction to the field for readers from a variety of backgrounds. No technical skills required. It starts with a historical perspective and a brief review of the challenges facing healthcare delivery as we all live longer and develop chronic diseases. It then focuses on the FHIR API-based interoperability standard that is having an enormously positive impact on innovation in the field and, in my view, offers great promise for really helping to overcome the challenges I reviewed earlier. I provide numerous case studies to demonstrate why that is the case.

After over 20 years in the commercial health IT segment I've been teaching at Georgia Tech since 2007 where I'm involved in various research projects and work with and advise numerous community and industry groups.

In my spare time I love to cook and enjoy fine wine!

Reviews

[John · Rating 3 out of 5]

This is a decent introduction to ideas around healthcare data interoperability (it's not really about the cloud; were it really about the cloud, it would include topics of burning interest to emergent healthcare companies: For instance, is Amazon's AWS really HIPAA compliant?).

The chapters are authoritative and explain why we need solid and deep analytics (e.g., to understand and treat chronic health issues, which are complex and need lots of data over time; and for the analysis of populations as opposed to individuals).

There are good explanations of SNOMED, the CCD standard, recent directions in EMR/EHRs, software specialized for "patient-centered care," patient portals, etc.

The author assumes that the reader has a high-level understand of HL7 and healthcare EDI (834's, 837's). However, I am sure this is a mistaken assumption. The books on HL7 and EDI stink or are quite old. A book like this would be significantly enhanced with additional chapters on HL7 today and EDI today. Seriously. This is a big gap. There is, for instance, no mention of Mirth Connect, which has emerged as the back office open source swiss army knife for messaging. There is rather a lot of key information that I think is locked up in Braunstein head that is obvious to him, but needs some working out at length by a good author such as himself. The new O'Reilly book Hacking Healthcare is part of the story, but Braunstein brings an academic's serious to the task, and I really think there is a better book that would be about twice as long as this one.

In short: The quality here is high, but it's too brief, and too much like an interim report.


One last thing:

The author acknowledges that a single health data model as in Indiana would be simpler and cheaper, but says: "However, the US is moving strongly away from this model in favor of a federated approach for both economic and political reasons" (p. 81). BOO!! Authors like Braunstein are positioned to argue strenuously against the status quo, and its incredible expense. I think that just rolling over and accepting an inefficient and wasteful system is not what a professor should be doing if he knows better.