We have been hearing a lot about digital health and electronic medical records over the past few years, and , given the rapidly evolving state of technologies and rules, we are likely to continue to do so in the future. The bugaboos are well known, but, it seems, there is more momentum to plug the gaps, particularly since taxpayers have spent billions to subsidize digitizing healthcare information.

As a result, patients, doctors and, now the US government, are putting more and more pressure on the HIT industry to get it right. They want these gaps closed:

But, there are even more to close:

1. The technology development gap, where designers don’t communicate or collaborate with end users.

2. The access gap, where both providers and patients get access to the internet and to enough bandwidth to manage the increasing amount of data. This is but one of many digital divides. The issues become even more pressing when we note that there are 4 billion people on the planet who are not connected. Getting them, and those in under served areas of more developed countries will have to address three main problems: affordability, relevance, and unfamiliarity.

It is also necessary to reduce regulations and subsidize the costs to get broadband into rural areas. We also need to accommodate more and more dedicated cell phone users cutting their home land lines and cable, thus limited data transfer capabilities.

Overall, the United States is digitizing rapidly. Between 2013 and 2017, national broadband adoption (the share of all households with a broadband subscription) rose from 73.4 percent to 83.5 percent, with adoption rising especially fast since 2015. This nearly matches the in-home, wireline subscription numbers the National Telecommunications and Information Administration (NTIA) reported in November 2017. Despite strong growth, however, tens of millions of households still lack broadband subscriptions. If this were our national rate of water access, it would equate to an emerging nation. This reality should be unacceptable.

3. The manpower gap, where we don’t train enough clinical infomaticians or data scientists in a reasonable amount of time, instead of requiring an MD, MBA and Masters in Information Systems or Computer Science.

4. The interoperability gap, where information can be globally exchanged from one patient or provider to another. Protect but share has not worked.

5. The data security gap, where almost every day we read about another hack of patient data.

6. The censorship gap, where some think EMRs are a threat to academic freedom and free speech

7. The EMR data ownership gap, where patients want to “own” their data not relinquish it to vendors , doctors or hospitals.

8. The usefulness gap, where electronic records are billing and collecting and profit generating instruments not designed to maximize patient care and reduce costs.

9. The aim gap, where the triple aim omits the experience of the healthcare users. There should be a quadruple aim.

10. The cost gap, where, particularly for small, independently owned practices, the costs of electronic medical data systems has become prohibitively expensive and another federal unfunded mandate further threatening private practice.

11. The healthIT gender pay gap

12. The doctor-patient data value gap. The vast majority of physicians say healthcare data is overwhelming, redundant and doesn’t make a difference in care quality. But most patients say their primary care physician’s office should store any personal health data they ask them to.

13. The evidence gap. While many apps have been technically and commercially validated, few have been clinically validated in clinical trials. The number of digital tools and applications available to reduce inefficiencies, improve access, reduce cost, increase quality, and make medicine more personalized for patients is growing exponentially. However, the tools and standards to evaluate their safety and efficacy are not well established. 

That’s according to a new Black Book research survey in which 94% of physicians said they’re deluged with what they think is useless data, while 91% of their tech-savvy patients want them to have more of it.

There is also a significant policy research gap confounded by poor research design or conflicts of interest.

So what is the treatment for digital health gaposis?

1. Focus on making digital health a subsegmented academic domain

2. Write an online textbook and case book

3. Craft a specific value proposition for the scientists, engineers, lawyers, business people, and health professionals

4. Create free, faster, smarter, more secure WiFI networks.

5. Create better knowledge exchange programs

6. Offer better experiential learning opportunities

7. Focus on creating user defined value, not investor defined companies

8. Prototype and simulate to verify and validate

9. Expand bioentrepreneurship education and training programs.

10. Reward faculty digital health innovation scholarship

11. Here are some other solutions suggested by the Commonwealth Fund:

“To move forward with consumer-mediated HIE, several steps will be required. First, the federal government needs to more aggressively enforce HIPAA’s information-sharing provisions. Second, we need a new cohort of health-data stewards who can help patients manage their own data. Some process of private certification or public regulation will likely be necessary to assure that these new entities can be trusted to discharge this sensitive and complex responsibility. Third, we will need to perfect the technical ability of these new data stewards to access the electronic-data repositories of health-care providers.”

The same organization has also offered these digital health solutions:

• Defining opportunities by focusing on the nation’s greatest health and delivery system problems.

• Closing knowledge gaps among consumers, technology developers, entrepreneurs, health care executives, and investors through networking and learning events.

• Creating test beds in care settings to validate the impact of innovations on quality, outcomes, and costs as well as on clinical and consumer experiences.

• Enabling consumer-centered design and valuations of new technologies.

• Addressing barriers to uptake, including operational factors and challenges related to an evolving reimbursement and policy landscape.

12. Remove regulatory and legal uncertainty and barriers to dissemination and implementation

Unfortunately, members of the digital health ecosystem are promoting self serving vanity numbers, not independent assessments of outcomes.

Doctors are spending too much time as data managers overseeing patients as data points using dysfunctional systems. As a result, we are getting the garbage out we would expect.