Recent events and some of my recent blog notes have caused me to question whether we need a new, high-level classification that encompasses all health information systems. I am going to give this idea a try. The goal of such a large scale systematic plan is to understand the functionality of current and future health information systems. Details are listed below:
1. Provider health systems (PHS's): The common feature of PHS's is that they are designed as tools for use by healthcare providers. The largest and most complex of these systems are EHR's which are deployed in hospitals and health systems. Also included in this category are office health systems (OHS's) designed to support the office functions needed by physicians and other providers like nurse practitioners. PHS's provide all the necessary IT functionality in health systems ranging from hospital inpatient units to the PCP's managing ambulatory patients.
Subcategories of PHS's include departmental systems deployed in hospitals such as LIS's, RIS's, and PAC's. In recent blog notes, I proposed that standalone LIS's, as opposed to LIS's that are part of the software suites of EHR vendors, could perhaps evolve into LIS-A's (see: Predicting the Future Functions of the LIS-Analytic (LIS-A); Continuing Discussion about the LIS of the Future; Analytics as a Key Feature?). Such systems would change from classic, best-of-breed LIS's to systems that support descriptive, predictive, and diagnostic algorithms. By developing such LIS-A's, LIS companies may cede ground to the LIS's provided by large EHR vendors as part of their enterprise-wide offerings.
2. Individual (or personal) health systems (IHS's): These are systems designed primarily for consumers. I blogged recently about the Rally system of UnitedHealth Group that initially provided coaching and other health services (see: UnitedHealth Group to Launch Its Own Variant of an EHR in 2019). It's similar to Apple Health which is an app that runs on iPhones and the Apple Watch. Analytics will be a major thrust in the consumer healthcare market and delivered via IHS's (see: The Future of the LIS: Reflections about Consumers Ordering Their Own Lab Tests) particularly when PHS/EHR clinical data can be downloaded by consumers from their EHR accounts. Apple is already providing such a feature for iPhones in collaboration with selected health systems (see: Apple Has Plans to Copy EHR Records to iPhones and Apple Watches).
3. Hybrid health systems (HHS's): These would be systems such as the one being developed by UnitedHealth Group mentioned above that span physican office health systems (OHS's) and individual health systems. The advantage of such systems is that they fulfill the desire of patients to share health measurements obtained in their homes such as EKG tracings recorded by their smart watches or home lab testing performed by devices that plug into their iPhones.
As to the future of health information systems, most of the development (and consumer market) is going to be related to IHS's and perhaps relatively simple hybrid systems. This is where consumers will be operating as well as health wearables and home testing devices. EHR's are expensive and accessed only via complex user interfaces. Hospitals will continue to use them because they have no substitute products. Consumers will never use them directly because of their complexity and because of the security concerns of the health systems that own and operate them.
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