A growing chorus of politicians is raising concerns over the inclusion of projects that would create green collar jobs (alternative energy and transit projects) and those that would finally bring about the digitization of medical records, because they are not "shovel-ready" and so would not create jobs
anytime soon. Rep. Baron Hill (Ind) argues to the Washington Post, ""If we're going to call it a stimulus package, it has to be stimulating
and has to be stimulating now. I think there are members of our caucus
who are trying to create a Christmas tree out of this." This is a red herring argument in the case of electronic medical records just as much as it is with regard to green collar jobs.
The design of a technical infrastructure for portable electronic medical records that includes all health care providers, consumers and researchers is as massive an undertaking as was the creation of the interstate highway system in the 50s, and will require thousands of design jobs.
The design of a technical infrastructure for portable electronic medical records is as massive an undertaking as was the creation of the interstate highway system in the 50s, and will require thousands of design jobs.
Why are thousands of designers required? The current DHS Secretary, Mike Leavitt, explains in a recent Washington Post editorial that simply providing millions of dollars for the purchase of heath IT systems that digitize patient records "could do more harm than good". The point is not to bring individual health care providers into the information age, the point is to share this information among health care providers, consumers and researchers. Leavitt explains, "If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed." The result would be a balloon in ongoing health care IT costs to integrate incompatible systems and an inability to rapidly create, deliver and bill for innovative health care services until dozens of incompatible systems were modified to support the new service. If this sounds like a doomsday scenario, just look at the current telecom industry, where exactly this scenario has existed for several years.
What design jobs are needed to avert this technical dead end and bring about all the benefits of portable electronic health records?
(1) Software Architects: It's faster and cheaper to design a single, closed IT system than to design one with an open architecture. Architects are required - working both for health IT vendors and for health care providers - to design technical interfaces that ensure critical health data isn't trapped inside expensive silos. Architects are also needed to design Enterprise Service Bus systems that are the physical plumbing of any Services-Oriented Architecture.
(2) Biomedical Ontologists and Standards Designers: It's not enough to design interoperability on a physical level, we must also design interoperability on a semantic level. This requires a common data model or ontology, enforced via a standard. This is no small task. Even philosophers are required for the job - as it requires a universal description of the types of activities, events and bodily parts and wholes that contribute to health.
(3) Organizational, Process & Quality System Designers: Digitization of medical records, like all IT projects, is not really about software, it's about processes. Providers and researchers will be doing their jobs differently as a result, and these new processes must be designed, documented, and then communicated back to health IT system designers. For example, electronic health records may eliminate many sources of medical errors (e.g. cross-drug effects) but they encourage many others, such as rushing through assessments during daily rounds now that one can "copy and paste" assessments from previous daily rounds. Process and Quality System designers are needed in large number to bring about the process changes that are required to leverage technology in health care.
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