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Articles :: More Healthcare IT Articles
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Connecting US Healthcare |
| By Obi Igbokwe - Email Obi Igbokwe |
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| A look at the recent efforts in the United States to encourage the adoption on interoperable healthcare technologies by healthcare organizations.
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On the 21st of July, 2004, Tommy Thompson, Secretary of the US Health and Human Health Services unveiled plans to tackle the one of the leading causes of death in America .
Thompson revealed that his department hopes to speed the adoption of healthcare technology by healthcare providers. It the next ten years it is hoped that many organizations would move away from a paper-based system to a digital system for patient records.
Paper-based systems for managing the care of patients are the norm in many healthcare organizations across the US but they are not without their problems.
Incomplete records in paper-based systems are commonplace and occur for a variety of reasons, especially when records are being transferred between departments or different healthcare entities and when under pressure or overworked healthcare providers fail to make the necessary entries during the care of a patient.
Another common problem with paper-based systems is the handwriting used to make entries in medical records. Quite often the handwriting is illegible and this can lead to a patient being misdiagnosed. Poor handwriting is also the chief culprit in misread prescriptions, this very often putting patients’ lives in danger and in some cases leading to death.
Misdiagnosis due to incomplete records and misread prescriptions are preventable and is also alarmingly the eight leading cause of deaths in the United States . About 98,000 people die every year due to preventable medical errors.
Electronic-based systems have been offered as a solution of solving this problem, more so as they been used in other industries to increase efficiency and improve the quality of services offered. It has however been said in terms of technology adoption the healthcare industry is said to be ten years behind most other industries.
They are various reasons for this and one of which is the fact that some of the information systems in place today are not interoperable. This has made healthcare providers hesitant to invest in systems that would operate in isolation.
The lack of interoperability between systems can be attributed to the previous lack of national health IT standards. This makes it impossible for information systems to transfer information between themselves and this is a cause of incomplete records in electronic-based systems.
The problems have been brought to the attention of the US government and it introduced two bills in 2003 to address some of these issues. On July 24, 2003 Congresswoman Nancy Johnson, introduced the “National Health Information Infrastructure Act of 2003” to the US Congress.
While the "Medication Errors Reduction Act of 2003," was introduced in October 2003 by Senator Olympia Snowe, and Senator Bob Graham, to make available grants up to the sum of $750,000 to hospitals and nursing facilities.
Both Acts were introduced to facilitate the acceleration of National health information technology standards adoption by healthcare organizations in the US and improve interoperability between the various information systems within the healthcare sector.
The US president, George Bush, then announced on the April 26, 2004 when he unveiled his ten year plan for healthcare, that he would be creating the position of the National Health Information Technology Coordinator.
The Officer, working under the Secretary of Health and Human Services, as stipulated in the “National Health Information Infrastructure Act” would work with public and private health care entities to develop a strategic plan to
? coordinate multiple public and private initiatives
? accelerate the adoption of voluntary national communications and data standards
? implement a national health information infrastructure
The announcement quickly followed by the appointment of David Brailer to the position. Brailer appointment was made by the secretary of the Department of Health and Human Services, Tommy Thompson and is seen as the right person for the job by many in the health informatics community.
Brailer, a physician, gained prominence when as the chairman of CareSciences, he oversaw the efforts to build the Santa Barbara County Care Data Exchange, a local effort to bring together hospitals, laboratories, and physicians groups to share data.
He has wasted no time to rallying physicians, health care organizations, government agencies, insurers and information technology providers to move quickly towards the implementation of interoperable information systems.
The US government has also established a program called the Consolidated Health Informatics (CHI) initiative. The aim of the program is to adopt a portfolio of existing health information interoperability standards within all agencies in the federal health enterprise.
On May 6, 2004, the Departments of Health and Human Services (HHS), Defense, and Veterans Affairs announced the adoption of 15 additional standards agreed to by the CHI initiative to allow for electronic exchange of clinical information across the federal government.
HHS also announced that it had made arrangements with the College of American Pathologists to make one of the standards, SNOMED CT freely available to users within the United States .
The US government is not the only one pushing for interoperability of health information systems, two other organizations, the eHealth Initiative and The National Alliance for Health Information Technology (the " Alliance ") have been pushing for the adoption of national health IT standards.
Both organizations are independent, not-for-profit outfits composed of various players in the healthcare sector. They both aim to work hand in hand with healthcare organizations to help accelerate the implementation of connected health information technology infrastructures.
In June 2004, the Alliance made public its directory of 850 voluntary and mandatory standards and electronic links to more than 200 standards development organizations. The Alliance also is developing members-only content to make the information even more useful, including detailed summaries and evaluations of the standards.
While both the Alliance and eHealth are making significant contributions in promoting the development and adoption of connecting technologies, the impetus seems to be going from the US government.
It has been said that vendors are sometimes reluctant to implement changes to make their products more compatible with that of their rivals, but IDX Systems is going against that perception and are actively involved in a federally funded project called the SAGE Project.
“SAGE” which stands for Standards-Based Sharable Active Guideline Environment aims to develop a standards-based comprehensive technology infrastructure that will enable encoding and dissemination of electronic clinical practice guidelines.
Connected systems might encourage more healthcare organizations to adopt healthcare technology; some experts believe that more needs to be done.
“There’s clearly movement from several directions in the federal government to promote increased use of information technology by health care providers, and I think that’s a good thing.” says Eric Rose, M.D. assistant professor at the Division of Biomedical and Health Informatics, University of Washington and Physician Consultant at healthcare IT vendor, IDX Systems.
“In particular, the national healthcare IT coordinator position is a hopeful sign. It remains to be seen what policies will come out of all this. One thing that I’d hope not to see is an unfunded mandate for physicians to adopt clinical information systems—that could create substantial financial stress for physician groups and also result in a backlash against a technology that a lot of physicians already look at with some scepticism.”
Tommy Thomson, the HHS secretary has however stated that there would be no federally pushed mandates for health IT, believing it to be too slow and reckons the quickest way to get hospitals wired up is by the government pushing standards and demonstration projects. A pilot portal which would allow patients online access to their medical records is currently in testing now, and will be conducted in Indiana later this year.
Dr. Rose also believes that other issues should also be considered in trying to encourage technology adoption, including more training for clinical informaticians and patient involvement in the adoption process.
He proposes a multi-pronged approach:
a) Incorporation of clinical informatics into the standard medical school curriculum. “If medical students are educated about the benefits and challenges of using electronic health record systems, they are more likely to successfully adopt the technology when they complete their training.”
b) Increased involvement of medical specialty societies in promoting technology adoption. “Some specialty societies are exploring ways to share informatics expertise through publications, person-to-person contact and informal mentoring. Hopefully this will become the norm.”
c) Group purchasing arrangements similar to that of the American Academy of Family Physicians’ (AAFP) Partners for Patients program. AAFP has signed agreements with a number of vendors which would enable its members to purchase products and services at a significantly reduced prices, and in some cases, obtain additional services at no cost.
Dr. Rose believes that all these along with the government putting its resources and influence toward the accelerated development of health IT standards and providing incentives to defray the financial impart of implementing technology adoption should make it easier for healthcare organizations to move towards having electronic-based systems.
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