20/20 Vision and Health Informatics in the 21st Century

Shepherdstown 06 September 2006Imagine a future healthcare system that is customer focused and patient-centered. One in which every American has health insurance, and a secure, private Electronic Health Record (EHR) whenever and wherever needed to realize highest degree of coordinated quality of medical care based on the latest medical knowledge and evidence.


Imagine a healthcare system in which digital and mobile technologies, medical knowledge at the point of need, and collaboration among providers delivers safe, high quality care for everyone. A healthcare system that does not require the same forms be completed at every care access point: primary care physicians have access to your specialty medical information and specialists have access to your primary care information via connected "smart" EHRs that are integrated with personalized eHealth service providers and delivered directly to a multi-purpose, intelligent, mobile digital device that can be carried in your pocket.

This consumer-centered system will use a variety of technologies and innovations that generate the "smart" EHRs of the future that:

  • Deliver information, services, and data via mobile, multi-purpose devices anywhere, anytime. Imagine a small Mobile Multi Purpose (MMP) communication and coaching device that has a phone, embedded health coach software, GPS, instant messaging (IM), camera, music player, and e-money dispenser - all of which are interconnected to deliver healthcare to active, busy Americans.
  • Remind you when it's time for your annual check up and anticipate your need with intelligent digital agents. Imagine embedded, health coach "mindware" programmed right in to that MMP. This mindware allows the device to "learn" each time additional medical data is added, and automated programs scan the Internet or licensed medical service databases for the latest medical research and knowledge relevant to your medical conditions and genomic type.
  • Integrate physician records, hospital services, medication histories, and other clinical information into a unified digital record that is available to patients at home or at the point of care. Imagine that accessing your health records or paying medical bills becomes as easy and convenient as checking your banking records or using online bill pay.
  • Monitor vital signs and clinical indicator continuously and communicate wirelessly and seamlessly. Imagine an easier way for diabetics to monitor their glucose levels using a glucose watch or implantable "nano-tear" - contact lens-like device that uses nano technology to monitor the glucose level in a person's tears then transmit the results to an MMP and dispenses insulin automatically via an implanted nano-device as needed. Such a subscription-based monitoring service could be sponsored by a doctor, hospital, health plan - maybe even your credit card company.

Medical Informatics has the power to deliver these services and many more. And in the year 2020 we will see a practical application of the creativity and genius of today's clinicians, researchers, patients and technologists who are working to help and heal. The following figure illustrates the concept of Health@Anywhere and shows how patients will evolve into medically empowered ConsumerMDs, surrounded and supported by a variety of interactive devices that deliver health and medical services at the point of need.

Medical Informatics in 2020 through its strategies, tactics, processes and technologies will surround and support patients wherever they are. It will engage patients to be active partners in their medical care. And as patients become partners in their own care, they will support efforts to continuously improve the quality of care, reduce deadly medical errors, and cut unnecessary costs. As the Health@Anywhere figure above illustrates, they will do this in a variety of ways:

  • Web of Care - Consumers will have "always on" access to public Internet and subscription-based medical/health knowledge databases that deliver a vital connection to rapidly access to medical knowledge based on interest, diagnosis, treatment protocol or topic of interest.
  • ePHR - The next generation ePersonal Health Record (ePHR) will be electronically connected, evolving with emerging technology, electronically connected to the Internet, and entelligent with the latest "health coach" mindware that reminds and anticipates health needs and enables the storage, management and intelligent use of a patient's personal medical record, health and medical care. The ePHR will be available through multiple options supported by a health partner such as a doctor, hospital, health plan, patient advocacy group for those with chronic disease, or financial services company.
  • Smart eHomes - Homes of the future will be embedded with all types of Net-connected monitors, including bio-monitors tailored to the individual needs of the residents. Bio-monitors could measure a patient gait or a pillow embedded monitor could track respiration. These technologies will involve simple, low-cost sensor technology affordable to even the lowest income earners. A data-mining element will yield additional health information for the linked ePHR, and the entire system will be customized to the individual and cultural needs.
  • Health Robots - "Healthbots" will assist elderly and special needs patients at home by reminding them to visit the bathroom, take medicine, or schedule an appointment with their doctor. These healthbots will also function as a conduit for connecting patients with caregivers through the Internet. Professional caregivers will directly interact with patients remotely, reducing the frequency of visits and collecting data and monitoring patient well-being along the way.
  • Anywhere@Decision Support - Consumer Health Informatics (CHI) will deliver tools, resources and support for patients and healthy people who need to better manage prevention and treatment decisions. These decision support modules will be tailored to individual demographics, health profile and conditions and delivered through print, Web, multi-media, video or any other communication vehicle.
  • Wearable BioSensors - Biosensors - detection devices that, when worn on certain body parts, search for and identify status indicators of a biological function such as heart rate and glucose levels - will painlessly provide needed information for prevention and treatment decisions. Today, the GlucoWatch provides diabetics with automatic, noninvasive glucose readings as frequently as every ten minutes. Biosensors do and will monitor everything from glucose levels and heart rhythms to cancer indicator molecules and brain function.
  • Implantable eCare - The insertion and management of artificial devices within the human body will become increasingly common for maintaining and improving health. "Implantables" have already evolved from artificial hips and knees to assistive devices that have built-in electronics such as artificial pacemakers or cochlear implants. Implantable eCare is the next wave: integrated, internal implants that communicate with external monitoring devices outside of the body and through the Internet.
  • NanoCare - Next generation Implantable eCare, NanoCare, is the creation of tiny (nano-sized) components that will be constructed, inserted, and applied within the human body. The National Institute of Health (NIH) Roadmap of Nanomedicine initiatives anticipates that in the next 20 to 30 years, nano-sized implants will search out and destroy cancer cells that would otherwise cause a tumor to develop in the body, and be used to create miniature, biological devices to replace a broken part of a cell. An insulin-dependent diabetic could use such devices to continuously monitor and adjust insulin levels autonomously and automatically.

Health@Anywhere examples above are all based on technologies that exist today and those that will be evolving in the not so far away future. Our health and medical system is transforming and segments of our customer focused and patient centered future are already in place. Now the challenge that exists for healthcare leaders, clinicians and managers is to plan for and deploy the knowledge and information technology tools that empower patients and enable care providers. Complex systems require comprehensive processes and tools to transform care processes. The transformation of processes must be guided by empowered and educated managers and clinicians within the framework of an advanced medical informatics paradigm. We call this the Medical Informatics Model 20/20.

The Medical Informatics 20/20 Model

Industries and businesses throughout the world are being revolutionized through the application of three unique and powerful strategies - Collaboration, Open Solutions, and Innovation. When combined, these strategies create a robust model for accelerating change, reducing medical errors, and improving quality in the U.S. healthcare system. We call this the Medical Informatics Model 20/20. The following figure clearly illustrates the model and its key strategies for improving quality of care.

The three major strategies of the Medical Informatics 20/20 Model are known as COSI - Collaboration, Open Solutions, and Innovation - are briefly described below.

  • Collaboration shares and disseminates knowledge, know-how and resources to healthcare leaders, patients, and consumers, allowing them to save time and money across our many health and medical industry tiers and markets.
  • Open Solutions facilitate the ability to communicate and share information in a way that is completely interoperable and transportable across large scale, macro-economic and information technology systems.
  • Innovation unleashes the knowledge and applied creativity power of team members in healthcare organizations to improve processes and transform culture to better serve customers, professionals, partners and patients.

The COSI strategies of Collaboration, Open Solutions and Innovation are absolutely essential for transforming the health and medical culture, the processes, the leadership and the technology necessary to support better, safer and higher quality care in the American health care system and health systems across the globe. In the early 21st century, the application of these strategies is already evident throughout all major industries.

The authors delve deeper into this area and further elaborate on the Medical Informatics 20/20 Model and the COSI strategies in their upcoming book entitled "Medical Informatics 2020" to be published later this Fall. See http://www.jbpub.com/catalog/0763739251


Douglas Goldstein is a "Practical Futurist", Author and President of Medical Alliances, Inc. He guides leading healthcare organizations in clinical and business performance improvement through intelligent use of technology, knowledge management and "Distinctive Innovation". He can be reached at doug@medicalalliances.com

Peter Groen was the former Director of the Health IT Sharing (HITS) program within the Veterans Health Administration of the U.S. Department of Veterans Affairs. He recently retired and is now on the faculty of the Computer & Information Sciences Department at Shepherd University in West Virginia. He can be reached at pgroen@shepherd.edu

Peter Groen, Douglas Goldstein

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