Mature Market Experts Gem of The Day: $20B For Healthcare Information Technology

j0438865 mature market electronic medical records

Mature Market Experts: more mature market news and stats more often – $20B For Healthcare Information Technology – All politics are local, so the saying goes. So, it is worth noting that the amount of money being allocated in the new recovery and reinvestment law will affect all of us in some way on a local level—either for the good or the bad. Of particular interest to me is the roughly $20B allocation associated with healthcare information technology. As healthcare and its peripheral topics are of interest to me by education, training and profession, this particular expenditure carries with it both hope and caution. The expenditure carries hope from the perspective that the promise of universal electronic medical records can ultimately improve the quality of care for us all. The caution is that the devil is in the details and there is the possibility—and likelihood—that the challenges associated with implementing and administering such a technological advancement will not be resolved for many years to come.

Returning to the “politics are local” theme for a moment, the challenges with universal health records (note: NOT universal health care…I’ll leave that political debate alone for the time being) are in their implementation and acceptance across the U.S. It is not sufficient to simply supply each primary care provider with a laptop computer…there is the issue of the medical record software itself. Both Microsoft and Google have made large investments in personalized health records (I have one myself). But access to these data, the adoption of the medium across the country, identification of the patient, securing and protecting the information from unauthorized review, and many other challenges are before us.

These challenges will not be resolved by merely spending ~$20B on healthcare information technology initiatives. To address these challenges requires a unified effort across multiple fronts, including breaching technological and sociological boundaries. The basic tenets of restricted and assured access as well as accuracy of the data are so significant and are of such dire import that their mentioning cannot be overemphasized. From an academic perspective one might conclude that “of course” these items and more must be guaranteed. However, we in the U.S. have at present no common standard for enabling and ensuring these two most basic of operational items in this day and age. Certainly the technologies exist to meet the demands of these key requirements. But, their seamless, universal application is presently not available nor enforceable throughout the continuum of care nationwide. This is so for many reasons. Key among these reasons is the lack of enforced standardization for interoperability among the many, many standalone healthcare information technology systems. Many lone islands are available which cannot communicate among one another. The investment required to achieve this feat is in no way trivial. Furthermore, common standards for storing this information so that it may be retrieved at a hospital, say, in Orlando, Florida while I am away on business, have yet to be put into place.

So, how do we proceed? Well, in order to achieve the vision, all hospitals that acquire new or upgrade existing healthcare information technology systems (inclusive of electronic enterprise health records) should mandate that these systems interoperate with each other so that orders, medications, patient vital signs, laboratory results, imagery, and other information can be shared seamlessly among the many disparate systems that can coexist within a healthcare enterprise. This implies that such systems must support common data and information communication frameworks such as those proffered by Health Level 7 (HL7), DICOM, and others. Furthermore, such systems must provide the capability to support role-based user access to all stored information so that patient data will only be revealed to individuals with a need to know. Special care must be given to any information such as patient data for numerous reasons including safety and privacy. Additionally, repositories of patient information must be made available to clinicians anywhere at any time. Access must be reliable, assured, the data must be accurate and beyond question in terms of its integrity.

The aforementioned requirements are only a subset of those needed to support a truly universal form of electronic health record throughout the many thousands of enterprises worldwide. I have not made mention of the standards of care and how these can vary worldwide. Even if such a universal medium for storing and accessing patient information were confined to the United States alone this is a nontrivial challenge. However, I believe it is necessary to overcome given the even greater challenge of improving the quality of healthcare and reducing its ponderous costs in the years to come.

Note: more blog entries on electronic medical records can be found here.


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