The time is now to implement health information technology nationwide.
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| Rod Piechowski | |
Health information technology is at a turning point. Although fewer than 20 percent of all hospitals have made significant advances in adopting information technology, everyone seems to finally understand the point its champions have been pressing: that IT can enable a new model of health care delivery in this country. The new model will improve patient safety, reduce costs, provide greater efficiency and improve access to data that can improve outcomes.
Getting there will require focus, cooperation and a lot of money. Unfortunately, given the current economic conditions, that last piece will present quite a challenge. However, it may be the scale of the economic challenges that acts as a catalyst, forcing us to think creatively, plan thoughtfully and act confidently to make the change.
Many hospitals have had ongoing IT projects for years, but even more are relative newcomers. If the time has truly come to see the nationwide application of information technology, we are in a better position because of this, as we can learn from the early adopters, scale up what we have learned from them, and apply those concepts to the national vision. So far, we have learned that IT can be expensive, that it can change an entire hospital’s culture whether it’s done correctly or not, and that it can save lives.
Behind the Progress in IT
The past five years, especially, have brought us dozens of harmonized standards, a certification process for electronic health record (EHR) systems, and a growing list of interconnected systems that exchange data every day. We must give credit to the work that has been done by the American Health Information Community, the Health Information Technology Standards Panel and the Certification Commission for Health Information Technology. These three organizations identify the types of health care activities that require standards; identify the standards required to support those activities or functions; and, using those standards, certify EHR systems as compliant with those standards.
American Health Information Community. The AHIC federal advisory body has been chaired by Health & Human Services Secretary Mike Leavitt and is composed of a group of business leaders and government agency representatives, each with expertise in health care and technology. The group looked at instances in which information technology could make a significant difference in health care delivery, such as remote monitoring, medication histories, and so forth. The group then prioritized them and created a use case for each. Secretary Leavitt’s continuous participation demonstrated his commitment and drive to advance the adoption of information technology, and kept AHIC in the forefront of health IT activities.
Health Information Technology Standards Panel. HITSP is a public-private cooperative formed to harmonize and implement the standards that enable the use cases created by AHIC. HITSP consists of almost 400 organizations that participate on its board and workgroups on a volunteer basis. The work is not easy, and debate can become quite passionate; nonetheless, the organization has delivered several sets of standards for acceptance by Secretary Leavitt. High on its list has been harmonizing the standards required to enable interoperability among EHR systems.
Certification Commission for Health Information Technology. At the end of the chain comes CCHIT, which certifies EHR systems using the standards as criteria. CCHIT was created to improve confidence in these products, to ensure that they do what they are designed to do. Lack of confidence in the EHR systems was seen as a big obstacle to making purchase decisions, especially among those providing ambulatory care. Since the first successful rounds of certification, CCHIT has begun certifying inpatient EHR systems and other products. So far CCHIT has certified more than 100 different systems.
The roles these three organizations play is important, as they will continue to lay the foundation upon which more sophisticated features and connectivity will develop. Their major contribution thus far has been to increasingly invalidate the argument that there are no standards for interoperability. There will be much more work for them as we begin to articulate the role IT will play as new health care delivery models emerge.
Future of EHR Systems
From a patient safety and quality standpoint, EHR systems will likely continue as the nexus of all health care information. This includes data sent from devices as well as information generated by decision support systems. The use of personal health records will continue to increase, and there will be demand for EHR access to communicate with the patient or to receive patient-managed data. Standards for data, communication, privacy and security will be required.
In addition, information technology will be absolutely essential to enable the medical home, where it can provide educational materials and wellness tools for the patient as well as decision support and medical records for the clinical staff. In a connected community, the records will already be available should a patient require hospitalization.
A growing movement toward a managed, standardized quality reporting process will create a need not only for the harmonization of quality measures, but also for EHR systems to extract and report information securely and seamlessly. Data can also be fed to public health agencies for analysis. With data in standardized form, this analysis can be accomplished much faster and more accurately. Countless hours will be saved if we develop a system in which we “collect data once, and use it many times” for quality, public health and best practice development. With enough information at this level, we can then improve the value of decision support systems while speeding up the dissemination of medical knowledge throughout the country.
The Work Ahead
There are still a few missing pieces, however, if EHR systems are to become the information nexus. Systems need to know how to find one piece of data and link it to related data. Hospitals, physician offices, physicians, medical devices, etc., all require unique identifiers. It’s the only way a computerized system can connect “what data” is coming from “which machine” on “which floor” and to “which patient” it is related.
Standardized product and device identifiers are coming, and we should see movement in that direction in 2009. If, however, we want to have a nationwide network of interoperable clinical information systems, one of the biggest challenges we must overcome is deciding on a standardized way to accurately and securely match patients with their electronic records.
Though such standardization was included as a part of HIPAA, the privacy issue became a huge debate, and Congress put a hold on the use of any federal funds to develop a national or unique patient identifier. This is unfortunate for a few reasons, but mostly because the situation helps perpetuate, in the minds of many, the idea that a national identifier for health care purposes also means creating a centralized database run by the government. Remember that “national” in this context refers only to the scope of the identifier’s uniqueness.
Patients could voluntarily have a unique number assigned through their primary care physician’s EHR system, which could still remain the primary source of records. There are a variety of ways to keep things secure from a technological standpoint. But unless the ID numbers are restricted for use only within the health care system, we will see the same unintended results that occurred when Social Security numbers were used outside of that system.
The government may not be working on this issue, but that doesn’t mean it has been forgotten. Markle Foundation’s Connecting for Health developed a framework to allow demographic matching of patients with their records in a federated model. A new organization, Global Patient Identifiers Inc., was created to promote its Voluntary Universal Healthcare Identification system. (Watch for presentations from this group at the TEPR+ and Healthcare Information and Management Systems Society conferences in 2009.)
And last fall, RAND Corporation published a paper on patient identification in which it compared the use of identifiers and demographic matching techniques. The National Alliance for Health Information Technology has also published a paper supporting the development of an identifier.
2009 will be the year we tackle a lot of difficult problems about health care and technology. Let’s not leave this critical issue behind.
Rod Piechowski is senior associate director, policy, at the American Hospital Association.
Editor’s note: This is the first installment in H&HN Weekly’s new Most Wired series. Each month, we will feature a column on information technology leadership and strategy. Next month: Partners HealthCare CIO John Glaser’s thoughts on process improvement.
Hospitals & Health Networks welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to H&HN Editor at (312) 422-4500, or mail them to Editor, Hospitals & Health Networks, Health Forum, One North Franklin, Chicago, IL 60606.
