Miss Pressley: Merry Christmas and Pass the Healthcare IT!

Wednesday, December 24, 2008

Merry Christmas and Pass the Healthcare IT!

The term "healthcare IT" was thrown around a lot during the recent presidential election. I've worked in healthcare IT over the past 5 years (officially) and was an unofficial system administrator over the computer system in the RT department I worked for as well (for another 5 years). So, I think it's safe to say, I have a decent grasp on the issues and have made a few observations along the way.

My issue with healthcare IT becoming somewhat of a political football is two fold. One, I think it is a great idea and two, I'm not sure the breadth of the issue has been thoroughly thought out.

Why is it a great idea? Because information is literally at the fingertips of the clinician taking care of patients. Nothing beats having all of those labs, progress notes and radiology results all in the same place, right in front of you - without having to call medical records to get old charts on a patient. Lists of medications taken at home versus what is given at the hospital are reconciled to avoid life threatening errors and billing can be done electronically when procedures are performed, saving loads of time and money and reducing administrative costs (maybe...).

What should be considered further as everyone pushes ahead with healthcare IT? The concept is great for hospital systems. For example, hospital system A which has 4 hospitals and 100 physician practices can all share their information for the purpose of patient care - and it works. But, if a patient ends up in hospital system C for one reason or another, the information contained at hospital system A isn't electronically transferred to hospital system C - because they have two different hospital information systems, radiology systems, lab information systems and the list goes on...

I've supported radiology systems (RIS and PACs), cardiac echo PACs, pharmacy, transcription and dictation and whatever else was needed at my former job. If a patient came in with a CD from a different hospital containing radiology images and reports, we had to deal with: making sure the person placing the CD in one of the PACs computers had administrative rights (I know this is a per application/system issue. We had the computers locked down - and rightfully so...), we had to decide if we were going to store the outside images in our database - or, if we could store them - but, why would we? And, what about the report and oh, what if the CD didn't come with a viewer - what happens now? Should the doctor, who is interested in diagnosing and helping the patient have to deal with all of the weird computer issues involved in looking at an X-ray from outside of their hospital's PACs system? Sounds like it would be easier to have sent the films along with the patient and not that CD...

I think it would be a shame to believe that the influx of healthcare IT for doctors offices and hospitals is a cure all, especially if the sharing of that information is limited. I can go on about other things, but I won't right now (sending patient information over the Internet?...); but, I hope you kind of understand where I'm going with this.

Well, it looks as if the outgoing Secretary for HHS, Mike Leavitt feels the same way. I'll end with his perspective on the issue:

Connecting The Medical Dots

By Mike Leavitt
Monday, December 22, 2008; A21

Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.

Before lawmakers act, they need to think: If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed.

Health IT systems produce value when they are interoperable. When they're not, doctors who invest in electronic health records cannot share information with each other or add lab results to your file or send electronic prescriptions to your pharmacist. They would have to use handwritten prescriptions and paper files in addition to their electronic files.

That's not the way 21st-century health care should work. Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content -- such as patients' diagnoses, allergies, medications, lab tests and medical directives -- is standard for every patient, every time.

We're already on the road to a system that is universally accessible and secure. Health information experts, with coordination by the Department of Health and Human Services, have been working on foundational health IT standards and have made substantial progress. Congress has approved our request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5 million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number.

We've also established an independent, voluntary, private-sector certifying body, the Certification Commission for Healthcare Information Technology (CCHIT). This body provides "gold standard" certification that electronic health records meet existing interoperability standards. Any stimulus money for electronic health records should go only to those with CCHIT certification.

Likewise, "infrastructure" investments should go only toward supporting exchanges of electronic health information that are compliant with nationally recognized standards. Indeed, supporting health information exchange would be an infrastructure investment that would accelerate public-private cooperation in standards harmonization and certification.

It is important that standards be vendor-neutral. Government should not be in the business of picking winners and losers.

Despite the urgent need to move beyond paper records, simply offering up funds in the stimulus package will not get the results we want. Instead, it may set our efforts back. Systems will be isolated; data indecipherable; health-care quality unimproved.

If we're going to build a 21st-century health infrastructure, we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve the quality of health care overall.

The writer is U.S. secretary of health and human services.

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