The year 2004 ushered in a taste of what is being called the “dot-gov” boom in health IT. Both Republicans and Democrats are eager to show their support. As Bush-appointed health IT czar David Brailer noted, “Theres a magic aura around this topic, because its really hard to figure out what to fight about.”
Another reason for the lack of struggle so far is that much of health IT remains in the discussion and planning stages. Stakeholders are working to agree on goals now, but they are sure to disagree when its time for specific action.
From the outside at least, the cooperation on goal-setting seems genuine. Competing stakeholders are actually trying to collaborate. And even if this determination is fueled by mandates from Medicare and ONCHIT (the Office of the National Health IT Coordinator), it still seems sincere.
So, while the details are hazy and will surely be contentious, the vision is clear, and it is grand:
Doctors and nurses get the information they need about a patient when they need it. If a patient ends up in the emergency room with a mysterious malady, medical staff can see instantly that, say, the patient recently filled a prescription for a new drug that can cause liver failure.
When patients change doctors, they dont have to waste time or risk faulty memories in bringing the next doctor up to speed. Previous care information is reliably updated and logically organized in the patients EHR (electronic health record).
Instead of new knowledge taking several years to filter into routine care, computerized advice is updated instantly based on new evidence and guidelines. Preventive care skyrockets, leading to a healthier nation.
Medical errors are slashed: Sloppy handwriting, forgetfulness and clerical errors cease to be hazardous. Computerized alerts and patient identification systems prevent patients from receiving the wrong treatments.
This vision will never be completely realized. Health IT may be a magical political topic, but its not a magical remedy, even for those with health insurance. Implemented badly, IT will decrease health care quality.
Useful health IT must put people first, and adjusting workflow to suit technology will have unintended consequences.
That caveat aside, health IT has gained true momentum and is expected to reap real, widespread benefits within the next few years.
Three important health IT events of 2004:
1. David Brailers appointment as national health IT coordinator may be the most useful thing that President Bush has done on this front. The MD and PhD is incredibly knowledgeable, universally admired and politically astute.
2. The newly created Certification Commission for Healthcare Information Technology wont certify its first product for a while, but its work will be essential for stakeholders with competing needs to trust each other.
Once the commission has figured out how to award its stamp of approval, gridlock around EHR may start to flow. Physicians will be less worried that massive technology investments will be rendered obsolete. Payers can be convinced that physicians are using health IT effectively and then can be more forthcoming with payments.
Vendors can spend less time flying sales and support staff to doctors offices and spend more resources improving products. This rosy picture wont happen automatically or completely, of course, but we should be headed in that direction.
3. An analysis from the nonprofit Markle Foundation clearly laid forth the lack of a credible business case for health IT—as well as an analysis of the policies and practices that stall it.
The report sums up several months collaborative work by heavy hitters in the industry including Brailer, who chaired the committee until his appointment as national health IT czar. The report describes what must happen to make EHRs a net financial gain for physicians.
Four important trends for 2004:
1. It takes a system. A patients health is not in the hands of an individual but in the hands of a team of specialists spread across hospitals, outpatient facilities and specialty facilities. Unfortunately, members of the team are only dimly aware that its other members even exist, even if they work in the building.
The IOM (Institute of Medicine) blames the bulk of medical errors on health care fragmentation, not on individual providers.
Though were not there yet, IT promises to move patients care into an organized system specifically set up to prevent errors, increase preventive care such as vaccinations and gauge its own performance.
2. Interoperability. Physicians, the government and other stakeholders are insisting that devices work together. A congressional advisory committee on interoperability was founded, as was a new interoperability steering committee within HIMSS (Health Information Management Systems Society).
3. Consorting. To make sure interoperability happens, and to represent their stakeholder interests, several consortia were founded this year. E-prescribing supporters, EHR vendors and others came together within their fields with the idea of bringing down barriers to selling their technology. Whats more, members of different groups are now talking to each other more frequently.
4. Opening wallets. Both the government and, more reluctantly, the payers are increasingly willing—in principle at least—to pay for health IT, including interacting with clinicians over the Internet and e-prescribing.
Three useful products of 2004:
1. A patient spends more time with nurses than with doctors, but so far, nurses needs have been neglected. A few products aimed specifically at this market were launched this year.
2. The most useful devices will not provide static information in emergency rooms, but will update information about patients with chronic conditions or older people who are at risk of falling or wandering.
3.The use of RFID technology to track drugs should greatly decrease counterfeiting.
Two products likely to be useless or worse:
1. RFID tracking on products and equipment is one thing. But such devices inserted in people, even if emergency rooms have the relevant technology, are likely to provide outdated, unreliable information. To get useful, static information to doctors, Medicalert bracelets or smartcards are a better bet.
2. Engineers often dont like to deal with mundane tasks such as making interfaces pretty, but neglecting such details can be deadly. In September, the recall of a software card for a Medtronic drug pump did not clearly label fields when doctors entered dosing schedules. When clinicians mistakenly entered dosing intervals in the minutes instead of hours field, some patents got drug overdoses, two of which were fatal.
Brailer is determined that health IT not become a reality only for the “haves.” He wants rural and poor doctors to have EHRs, too. That laudable goal ignores a harsher reality. Health care itself is already a service for the “haves.”
This points to something more devious than any specific product: the notion of health IT itself. With all of its potential, its proponents sometimes forget that it is not an end in itself, but a means toward better health care.
Clinicians and policy makers must not let enthusiasm for health IT distract from the more mundane, and complex, problem of health care access.