Care, Not Just Cost Control, Should be Cornerstone for Health IT Highway
By Miles Varn, M.D.
Chief Medical Officer, PinnacleCare
Health care is our perhaps our nation’s most scientifically advanced yet technologically underdeveloped industry, at least when it comes to information technology. Paper is still the order of the day in many aspects of medicine, a field that is too complex and rapidly changing to exist in a paper world. So, notwithstanding legitimate privacy concerns, the provisions in the stimulus legislation – providing $19 billion for health care IT – is expected to move this important effort forward. But the tough job of creating the standards and implementing the technology lies ahead.
Building the health care IT highway is not a new idea; it’s been widely advocated here and abroad for many years. Technology is important not only for the sake of efficiency but for communication, collaboration and accuracy. Privacy concerns, implementation costs and standardization have all been obstacles to creating a national health information infrastructure and uniform electronic medical records.
There are two central promises in making this investment – gains in efficiency and gains in quality of care. One promise is the elimination of paperwork and reduced costs, and the other is better care management with fewer medical mistakes. While costs are important, quality of care is what most concerns physicians.
Some hospitals have already gone digital and are ahead of the curve, including most of the nation’s top centers of medical excellence. I liaise with those institutions every day and what they have accomplished is extremely impressive. But each is different. There are no standards for medical records, so hospitals do not electronically communicate with one another – what technologists call interoperability. Millions have been invested in these systems and interoperability will be a challenge. And, even centers of medical excellence with the best of systems have gaps; for example, not all include digital images in their patient records. If you are being treated in New York for a brain anomaly and collapse while traveling in Los Angeles, you’ll want local physicians to have immediate access to your last CAT scan for comparison, so that both medical teams can quickly assess changes.
It’s precisely that kind of emergency scenario that has led many people to invest in collecting and electronically storing their personal family medical records – which are an integral part of the health IT highway. Personal health records (PHRs) are controlled by individuals, or by an advocate on their behalf, while electronic health records (EHRs) are provider generated. The company I work for has professionally converted PHR records for more than a thousand of our members, and it’s easy to see where there are pitfalls for the do-it-yourselfer. There are many low- or no-cost software options in transferring family health records from a box of paper files to a digital format. However, if not organized properly and continuously updated, this may offer nothing more than a false sense of security. In an emergency room situation, expecting physicians to sort through a disorganized “electronic carton” to find vital information is no more useful than its cardboard counterpart. The public will need guidance in doing this, and standards may be important here, too.
The new legislation establishes aggressive timelines for implementation, yet standards issues are not resolved. We should look to the nation’s centers of medical excellence as best-practice models. They are care-centered innovators who can and should inform the roadmap for the health care IT highway. If, for the sake of expediency, the bar is set too low, taxpayers could end up spending $19 billion on technology that reduces certain costs but does not exploit the full potential of technology to improve care.
