National Health IT Week Thoughts: Let’s Replace “Meaningful Use” With “Meaningful Creation” or, Health IT, Join The Maker Movement!

After a lengthy preamble (I like lengthy preambles, to write them, that is!) I’ll answer each to this week’s (Friday, Noon, EST) #HITsm tweetchat questions.

  1. Topic 1: What #healthIT value proposition would you prioritize for Congress? How will their buy-in/participation drive long-term change? #HITsm
  2. Topic 2: How can federal agencies more significantly impact progressive #healthIT implementation and use for their stakeholders? #HITsm
  3. Topic 3: How can #healthcare balance clinical needs for evidence-based mobile medicine & consumer demand for behavior change tech? #HITsm
  4. Topic 4: Reflecting on another great #NHITweek, what have you observed as missing from the collective #healthIT conversation? #HITsm

I’d like to make an immodest proposal. Instead of debating whether to call healthcare users patients or consumers, let’s replace that whole consumers-who-use-healthcare paradigm with producers-who-create-health.

Huh? OK, that “sounds” great, but what do you (I) really mean? I mean health IT should become more like the Maker Movement. Here’s how Wikipedia describes Maker Culture:

“‘Maker culture’ emphasizes learning-through-doing (constructivism) in a social environment. Maker culture emphasizes informal, networked, peer-led, and shared learning motivated by fun and self-fulfillment.[2] Maker culture encourages novel applications of technologies, and the exploration of intersections between traditionally separate domains and ways of working including metal-working, calligraphy, film making, and computer programming. Community interaction and knowledge sharing are often mediated through networked technologies, with websites and social media tools forming the basis of knowledge repositories and a central channel for information sharing and exchange of ideas, and focused through social meetings in shared spaces such as hackspaces. Maker culture has attracted the interest of educators concerned about students’ disengagement from STEM subjects (science, technology, engineering and mathematics) in formal educational settings. Maker culture is seen as having the potential to contribute to a more participatory approach and create new pathways into topics that will make them more alive and relevant to learners.” (my emphasis)

What would a Health IT Maker Movement look like?

First of all we should examine what might seem like obvious differences between what Makers do and what Health IT people do. (I’ll use some simplistic stereotypes here…) Health IT people write (test, install, train, maintain…) software. Makers make physical things. Health IT saves lives. Makers make gadgets, interactive toys, performance art, that entertain, well, mostly other Makers. Health IT people mostly do what bureaucrats tell them. Makers mostly don’t.

Now let me be clear. When I’m sick, I don’t want to be dependent on some hobbyist’s personally soldered heart monitor. However, Health IT could surely use a good dose of whatever it is those Maker’s are… well never mind that. What I am talking about here is thinking different, figuring out how to do it cheap, and, most important, the energizing feeling of empowerment that comes from taking control of the means of production. That last phrase? No, I’m not a socialist. I’m a good-ol-fashioned American small business capitalist. I’d like to see us return to our roots, our invented-in-a-garage-roots, as in can you say Apple Computer?

One more thing! (Before I get to this week’s four #HITsm questions.) Think about this. If we can put tools in the hands of physicians to create their own workflows… If we can put fashionable wearables on the wrists and other body parts of… of … I think I’ll call them “im-patients”, maybe we can finally begin to create the out-of-office physician/patient workflows we need.

Topic 1: What #healthIT value proposition would you prioritize for Congress? How will their buy-in/participation drive long-term change? #HITsm

Turn patients and providers into inventors and producers of healthcare and health, instead of consumers and users.

Topic 2: How can federal agencies more significantly impact progressive #healthIT implementation and use for their stakeholders? #HITsm

Playing a supportive, not directive, role, much as the some federal agencies are beginning to support makers and factories re-kickstart American manufacturing.

Topic 3: How can #healthcare balance clinical needs for evidence-based mobile medicine & consumer demand for behavior change tech? #HITsm

Instead of focusing on getting patient-generated data into the EHR, focus on getting EHR data into the wearable (and associated apps). By the way, consumers aren’t demanding behavior change tech. No one likes change. Seed and fund STEM (and SHTEAM) Maker-style facilities, resources, gatherings and initiatives. Convert consumers from users to im-patient health producers. Harness their insight and lived experience to create “behavior change tech” that doesn’t look or sound like “behavior change tech.”

Topic 4: Reflecting on another great #NHITweek, what have you observed as missing from the collective #healthIT conversation? #HITsm

Workflow.

Workflow “is” the interface between people and technology. Most problems with usability, blamed for lack of EHR and HIT adoption, boils down to problems with workflow. Just as the Maker Movement emphasizes putting physical tools in the hands of the people, let’s put IT tools in the hands of the people. Just as it would be inappropriate to put million dollar factory machinery in the hands of the people, so we put 3D printers and easy-to-use microelectronics there, lets put easy-to-use workflow tech into the hands of clinicians, so the folks who know their workflows best can design the workflows of the systems they use to do their work.

I’ll wind up with a quote from the Maker Movement Manifesto:

“Making is fundamental to what it means to be human. We must make, create, and express ourselves to feel whole. There is something unique about making physical things. These things are like little pieces of us and seem to embody portions of our souls.”

P.S. While making physical objects can be empowering, programming is empowering too. So when I speak of a Health IT Maker Movement I include both fabrication and programming in its empowering machinery. Many of the “physical things” Makers make are interactive, intelligent, talking to the cloud, communicate with other physical things. And the medium that makes this possible is software. But I don’t want physicians programming in Java and C#! (unless they want to) I want physicians to take back control of their workflows by programming their workflows. This kind of programming, relying on graphical editors and editable workflow checklists, does *not* require a degree in computer science.

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