Take almost any piece of software specific to healthcare and stick it in a time machine, and send it back twenty years. Do you think the folks on the receiving end are going to be incredibly impressed? In almost every case, I just don’t think so. Usability of most healthcare information technology, far too often, seems to be an afterthought. If it was a thought at all, actually. (There are a few exceptions. Just not many.)

For the first time, in one hand, you have a lightweight, affordable, wireless touchscreen tablet with a battery that would make it through an extended shift. In the other hand, you have a cheap, $69 dock that turns this same portable tablet into a potential data entry workhorse at any bedside or in any exam room. Put those two together with a user interface that was designed to make it really difficult for you to build an unintuitive application. Do you see?

The information security infrastructure has to be there (and Apple has shown with the iPhone that they understand this, too). For that matter, the app itself has to be there. Lots of pieces have to come into place. But they will, because the opportunity is too big. Epic is already thinking about the space with Haiku. Allscripts has an impressive BlackBerry app, they are in the right place. athenahealth is probably closer than anybody, since their client-side platform is just about as adaptable as it gets. And I know of one little startup that was already working on this opportunity before I even started writing this little blog post…

Do you want to put a thin client in every patient room and exam room? Assign an expensive, (barely) mobile cart with every nurse? How about a heavy and unintuitive touchscreen notebook for every physician? Up until January 27, almost every endpoint option was counterintuitive to actually simplifying healthcare. The iPad (and other devices that will follow it) finally changes that dynamic.

Update: On the usability front, somebody at least agrees with me! The Commerce Department’s National Institute for Standards and Technology plans to develop standards to help evaluate the ease-of-use of healthcare [information technology] systems… I can’t help but think of Ronald Reagan and his likely concern with such an idea: “I’m from the government and I’m here to help.” But we shall see… On the other hand, John Halamka doesn’t entirely agree, at least not yet.

Last year, The Health Care Blog started Engage With Grace, asking you to take a moment over the Thanksgiving weekend to discuss your desires for how to live the end of your life as meaningfully as possible. If you would like to reproduce this post on your blog (or anywhere), you can base your post off of this version (which is what I’ve done here, thanks to Alexandra Drane, the Engage With Grace team, and Matthew Holt — via Bob Coffield).

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My mother passed away on April 18. I still have no words, but I have to express my deepest appreciation to everyone who has shared kind words and warm thoughts. It has meant so much more to me over the past few days than you can imagine. From the bottom of my heart, thank you so much.

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Angela Braly has a tough job. She became chief executive of WellPoint in early 2007. Right out of the gate she had to fire her chief financial officer due to “misconduct unrelated” to the company. Not long thereafter, the economy began crumbling, taking an especially heavy toll on health insurers, like WellPoint. Proving that there’s no rest for the weary, though, this year is starting off with the troubling news that the government is forcing WellPoint to temporarily suspend Medicare enrollments due to compliance issues.

Let me say that I think that Angela Braly has done a world of good at WellPoint. Not long after the situation with the chief financial officer, she hired a tough new compliance chief. The National Committee for Quality Assurance praised the firm last year for its work to improve care to minority communities. And, WellPoint was recently named to a list of the “best” employers in healthcare.

Still, the news from the Center for Medicare and Medicaid Services is disappointing, and the company’s response is, quite frankly, inadequate. The Bloomberg story on the Medicare suspension cites “computer mistakes,” “computer failures,” and “problems with [...] computer systems.” The company ousted its chief information officer last May, and finalized its new information technology team in September.

(While simultaneously blaming information technology for its Medicare problems, WellPoint is also talking about “electronic healthcare leadership” on its front page. Note to WellPoint media relations: probably not the issue you want to be promoting for a little while.)

WellPoint isn’t talking details, and neither is CMS. But this sounds like some sort of information systems disaster that, as best as I can tell, must be eating up claims and approval data and processes. WellPoint says CMS got involved six months ago, presumably around July of last year. But the company ousted its CIO in May of last year, I’m betting for the same reasons. Why they couldn’t have righted this problem, or at least convinced CMS that they were on the right track, after almost three quarters of “realignment” is not a good sign.

The bottom line is that, across healthcare, there’s a fundamental disconnect in the prioritization of information technology resources. Gobs of resources are being devoted to attention-getting personal health records and the like, meanwhile the folks in charge of core information systems are left to fight for whatever they can get.

Process reliability, systems uptime, data integrity, all things that can drown out the attractive message of “patient connectedness” — so the real priorities tend to be moved down the priority list, at tremendous long-term cost (ask WellPoint). And while I do believe patient-accessible electronic health records are an important part of where we need to be heading in healthcare, it can’t be at the expense of the actual healthcare information technology infrastructure itself. While that may seem like common sense, remind me again why WellPoint is getting a whopping seven “eHealthcare Leadership Awards”? And WellPoint is by no means alone in that sort of irony.

I started this article by saying that Angela Braly has a tough job. It turns out she’s not the only one with a tough job at WellPoint. Lori Beer, the woman appointed to the chief information officer position just a few months ago, now has the weight of the world (and CMS, which is probably even heavier) on her shoulders.