Pushing New Standards on to Practice

It's no wonder the newly appointed IT health czar has his hands full, with many factors standing in the way of the adoption of new technology in the field.

Our health-care system is perverse. Doctors and hospitals get paid by the procedure, yet they are the very ones expected to pay for health information technology that could eliminate duplicate and unnecessary exams, doctor visits and hospital stays.

According to an editorial in The New York Times earlier this month by Newt Gingrich and Rep. Patrick Kennedy, nearly 30 percent of the countrys medical costs do not go toward improving patients health.

Of course, Im not saying that health-care providers actually want redundancy, but one can see why health IT is a low priority, especially when many physicians are skeptical of its benefits and familiar with its costs.

Its no wonder that much of the new health IT czars job is looking for incentives for health-care personnel to adopt health information technology, and that groups such as the Foundation for eHealth Initiative have taken up in-depth studies on how to push IT onto health-care providers. Its also no wonder that insurance companies appear to be the main champions of this technology.

/zimages/7/28571.gifClick here to read about WebMDs transaction-services push.

But the health-care providers Ive spoken with see little benefit and much wasted time. To many, electronic medical records simply mean that a document is e-mailed rather than written, and they mention none of the benefits of automating, cross-checking, etc.

Having separate systems to track different aspects of the same procedure just makes matters worse. One nurse practitioner complained that every time she gave a vaccine, she had to record information in eight different places—and that she spent as much or more time writing information as she did seeing patients.

This is hardly a situation that will make health-care providers tolerant of new technologies, let alone willing to embrace them. Add the fact that many health IT providers feel they would earn more money in another specialty, as well as the fragmented nature of the health-care market, and the task of integration looms particularly large.

Last weeks unveiling of the latest draft of health-care IT standards gave some room for hope. The draft sets forth essential functions of electronic health records for providers and vendors, and it promises to help providers express their needs more clearly to vendors.

The U.S. government charged Health Level Seven Inc. (HL7) with the task. The decision made sense, as the organization is accredited by the American National Standards Institute and has had a subgroup working on electronic health records since 2001, according to the publication Modern Physician.

The current draft includes several "visionary" functions that do not exist in current electronic health records.

They include real-time reporting to public health agencies and the sending of alerts more sophisticated than the current ones on drug-drug interactions, plus the triggering of summaries of evidence-based medicine, which would help gauge the effectiveness of certain treatments.

Other standards adopted would ease the reporting of laboratory results. These include SNOMED Clinical Terms, freely available from the National Library of Medicines Unified Medical Language System; HL7 vocabulary standards for units of measure, lab visits, immunizations and demographic information; and Logical Observation Identifier Name Codes (LOINC), which ease the electronic exchange of laboratory test orders and drug-label section headers.

More standards refer to drugs and dosages, and environmental exposure to chemicals.

HL7 will be moving to finalize the draft of standards over the next two years. But for this to make a difference in health care, other forces must be moving to encourage health-care providers to use the tools that implement these standards.

Remember Esperanto, the global language movement with its invented language? A common language is useful only if people actually use it.

The Bush administration has appointed David Brailer to be one of these forces, to the wide acclaim of groups already pushing for health information technology.

But for a real response, Brailers call must be compelling to those at patients bedsides.

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