eHealth Solutions: Boom or Bust?

Dr. Lester E. Wold
Published on


For over three decades, information technology has had an impact on the delivery of healthcare globally. I believe it is fair to say that on balance over the course of that period, both providers and patients have been disappointed by the impact of health care related IT. Providers now commonly feel as if they are working for an electronic medical record (EMR) rather than having the EMR work for them. Patients are often frustrated by the need to repeatedly re-enter information which hasn’t changed since the last time they accessed care. Even the billing office has at times experienced the disappointment as the implementation of IT systems have not necessarily resulted in cost savings or improved accuracy in coding. Are health care systems globally doomed to continuously replay this broken record?

There is no question that the results associated with the implementation of information technology in healthcare has not lived up to the hype related to the technology. As chairman of a large department which was heavily dependent upon IT, I found it frustrating to see a growing portion of our resources going to support IT needs. IT was and is not our core capability and although necessary, it does not add value proportionally to the amount of resources spent supporting it. Like many areas of healthcare, there are few good studies to validate statements regarding value, but that is my impression. I believe that impression is broadly shared by providers, resulting in overall frustration.

There is however reason to believe that with appropriate focus and more effective engagement of key stakeholder groups, eHealth solutions can be a major part of the solution to global healthcare problems. In order to realize this potential, the eHealth solutions need to be developed and implemented in a different way. The technology needs to address real world problems faced by patients, providers and payers. In this regard, there may need to be some trade-offs as optimizing an eHealth solution from the perspective of any one stakeholder group will likely lead to a frustrating solution for at least one of the other two major stakeholder groups. Nevertheless, it is possible to develop a solution which is viewed positively by all major stakeholders.

An example of a successful eHealth solution, which was developed with involvement of major stakeholder groups, is the GDMS solution used at Mayo Clinic in Rochester, Minnesota. Over a decade ago, Mayo realized that there was a need for a digital solution to better meet the needs of patients and providers. GDMS (Generic Disease Management System) was developed with the goal of better meeting patient needs related to preventive services and to aid providers to be able to more efficiently identify which preventive services individual patients needed. This solution accesses data from multiple electronic systems supporting the Mayo practice and through a series of rules is able to identify patients who would benefit from a screening or other service [1].

The results of implementation of the GDMS were impressive. They included improved individual patient engagement, improvement in workflow for providers and allied health professional staffs resulting in significant time savings for both groups and significant improvement in the use of preventive services (e.g. 376% increase in the appropriate use of Varicella Zoster vaccination and a five-fold increase in timely rescreening for abdominal aortic aneurysm). These results arguably address the triple aim of improved patient experience, improved outcomes and lower costs.

In my experience, it is almost a certainty that there will be problems
with an IT implementation. At the worst end of the spectrum you have projects which get started and never finished for a number of reasons. GDMS was a successful project but it did not get rolled out to all Mayo Clinic sites for a variety of reasons, including the fact that within the Mayo system there were/are multiple EMR vendors. However, the capabilities supported by GDMS have now been expanded to other areas and Mayo is investing resources to expand upon the lessons learned from the development and implementation of GDMS.

So, what are the lessons from the GDMS experiment that can be applied more generally to ensure that eHealth solutions meet the needs of key stakeholders in global healthcare? Dr Rajeev Chaudhry and his colleagues at Mayo identified the following as key lessons learned from the development and implementation of GDMS:

  1. Data needs to be stored and accessible electronically
  2. Workflows must be well understood of any eHealth solution
  3. Involvement of the patient in the design process is critical

These lessons may seem obvious, but all too frequently eHealth solutions are designed in a technological vacuum. Such solutions may be elegant in terms of their technology, but will ultimately fail as they do not meet real world needs.

In the past three decades, we have collectively learned some
painful lessons related to IT in healthcare. The good news is that we can learn from that history. I feel confident that we will by focusing on the lessons learned from projects like GDMS. Breaking down the information and data silos which are all too common today is essential for us to realize this goal. Regulatory agencies play an important role in this regard but the sooner that vendors, providers, patients and regulators realize that we need to collectively work towards this common goal the faster we will be able to realize our aspirational dreams. Together we can make eHealth solutions a “boom” for healthcare and avoid them becoming a “bust.”.


  1. Chaudhry R. et al. Innovations in the delivery of primary care services using a software solution: the Mayo Clinic’s Generic Disease Management System. The International Journal of Person Centered Medicine. Vol 2 Issue 3 pp 361-367


Dr. Lester E. Wold

Les Wold is a physician who spent 29 years in training and practice at Mayo Clinic. During that time, he had numerous roles and responsibilities including Chair of the Department of Laboratory Medicine and Pathology, Medical Director, Mayo Clinic Ventures, Chair of Mayo Collaborative Services Board and member of the Mayo Clinic Board of Trustees. Since retiring from Mayo Clinic, he has been Chief Medical Officer at JARI Research, Chief Medical Officer at VitalHealth Software, Special Advisor at Noaber Foundation, and has held positions on multiple boards and scientific advisory committees. He firmly believes that eHealth/IT can play a critical role in transforming the delivery of health care services globally.