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Mr. President, there's something BIG you're missing
Dear President Obama:
So, you're looking forward to seeing the country adopt one of your most treasured goals, the complete data-meld of the healthcare industry. We're talking about having all patient data flowing liquidly between all providers with a few clicks of a mouse. Grandma will be able to move from her home in Topeka to her retirement condo in Florida and her data will be there in a millisecond, well before she has her first primary care check-up.
Yes, I understand why this sounds like a feasible vision to you. I'm sure you've thought about something like this every time you use your ATM card (well, maybe you don't use one any more--a president can't be too careful). Why, you probably wondered, can banks share financial information everywhere and anywhere, while I can't go across town from one doctor to another without running into great big hassles over getting my medical records into the right hands.
The problem is, you've probably made the same error that many people do in assuming that banks and healthcare institutions are alike enough to solve problems in the same way. The truth is, banks are inherently national and ultimately global institutions, and have had to develop coherent standards for sharing data in milliseconds from the inception of electronic networking.
But when it comes to healthcare, we're talking about a bunch of dots on a map, a mosaic spanning everything from several-hundred-hospital chains to fiercely-independent two- or three-person medical practices who do things exactly as they please. While banks, by definition, are pretty much automated to the teeth, healthcare organizations range all over the map from some that barely use email to others that track patients with 21st century sensors as they move through the building--and everything in between.
Sure, you may be reassured that if a hospital buys an EMR that's certified by the CCHIT, it's compatible with other CCHIT-certified EMRs, and yes, that's good for something. Lord knows, it's a start. But it's only a start. What about connections between existing health information exchanges? Do we close them down, force them to change the standards upon which they operate (an extremely NON-trivial matter), or bypass them? What about networks between hospitals and affiliated doctors that are working just fine, but don't meet current CCHIT standards? And what about connecting to the National Health Information Network using its CONNECT protocol?
With all due respect, Mr. President, the idea that healthcare can just be nudged into national health data networking in a few short years is so flawed it's almost comical. (And hey, this is coming from one of your fans.)
By all means, I appreciate your leadership on this issue. Somebody had to point at the moon and say "We can get there." And if national health data networking is a worthy goal, why shouldn't it be you who points the way? But if you think we can pull this off during your presidency, or your wife's, I believe you're missing something very big. Health IT just isn't going to be tamed at this pace, hope as you might.
Sincerely,
Comments
Anne,
Bravo! A great read and light way to get a point across. Being in the insurance reimbursement business, and traveling from Dr to Dr office, it has amazed me how many doctors are still on paper. From appointment setting, to the billing(except Medicare, of course). A majority of Dr offices are not even aware of the RAC audits.Change is not an easy task for medical practice. I enjoy your articles.Technology, and just everything in general is moving quickly, so I appreciate the articles you write. Thanks Anne!
With Integrity, Allison
I beg to differ and the president is probably got people like the CEO of Kaiser Permanente advising him on the work that is being done by KP, Goggle, Microsoft and Oracle and host of other software vendor in collaboration with medical insurance organisations.
The case for an Electronic Medical Record EMR or Electronic Health Record EHR was made more than 2 years ago and some of us were priveledged to have attended a World of Health IT in Geneva back in 2007 where that is all that was discussed throughout.
All the points you raise are the same ones everyone raised when Microsoft came in with Windows and those that embraced the technology are winners today.
I work for a medical aid society in backward Zimbabwe and we ALL agree the EMR/EHR is the way to go.
The President has it right my lady!
Mr. Takawira, "people like the CEO of Kaiser Permanente advising" might not be the best example. In April through June of this year I attended to the care of a surgery patient in Kaiser P. The Surgeon based in SF could access neither the post surgical care records from the Concord hospital nor the post discharge records from San Rafael. The San Rafael Drs could not access post surgery care records from Concord and did not even know who the surgeon was. That happened three emergency visits in four weeks. Finally the Surgeon called the patient in to SF facility where she COULD oversee the care. Not Good. Three different "regions", three separate systems; less than 80 miles in the same comprehensive hmo in a densely populated metropolitan area where a population commutes across 'region' borders daily. Damn good thing we carried the baggage of a folder of hard copies and a comprehensive list of names and titles and phone numbers. Hell, they could not even access a simple directory of doctors and phone numbers. Still we had to hard-press and up the ante to get them to use all the info we had access instructions to. Just not good. .....niiiii
Anne,
Absolutely brilliant! And wouldn't it be great if Rahm or Zeke Emanuel (plus the numerous others in Obama's world like Siebelius, Orszag et al) saw it also?
It's just maddening that we have this wonderfully charismatic communicator-in-chief who can't seem to find the time to deliver a talk about EHR at your level, as opposed to sound bites in airplane hangers?
On substance, I believe we need to use EU type smart cards to store basic patient data --for patients who chose to have such cards--and then employ the strong security of those devices to control access to/from/between Providers and insurers.
That would mean essentially ditching the impossible notion of "interoperability" as well as the naive notion that "somehow" we could develop a system capable of reading all legacy systems. So what?
I believe the large EHR vendors own DC. PERIOD.
Again, great work!
Stuart,
Thank you! I invite you to check out mymedicalmemory.org. I am an ER doctor who got tired (and is STILL tired) of waiting for someone to solve this. My partners and I have solved it with a smartcard solution that, indeed, negates the interoperability model, allows for role based access to information and avoids all the pitfalls and hurdles that have been presented. Thank you for your insight and understanding of this! Why is this concept so hard to grasp!?!?
You might want to check out the work that the National Coalition for Health Integration is doing (www.nchiconnect.org). NCHI is building a national healthcare information technology grid that can effectively (and securely) share information between disparate legacy EMR systems. Pilots proving the technology are already up and running. Will it be easy to roll this out nationwide? Of course not. But it is definitely possible, and we are building a nationwide coalition of healthcare industry stakeholders to make it happen!
Thank you for your rebuttal to Anne's message. There is no doubt in my mind that with the multiple approaches to solving interoperability issues, the NHIN will happen. Perhaps as a "network of networks" as Dr. Halamka has stated.
I wish to address the issue of "securely" which is the achilles heel of data transfer. I am working with a company that has developed unique biometric technology for mitigating data theft and breaches. Please review their website www.me4sure.com. Should you be involved in the current effort feel free to contact me or the company to discuss the issue. Thanks. LP
Anyone thinking that this could happen is very ignorant of the state of data processing and software analysis, design and implementation.
Might as well say we are going to implement the StarTrek transported by this friday.
Beside that - given how insecure our systems and networks are (and the government is a leader in that area) - just say "No" like Nancy used to say.
In a linear world what you say may be true, however, the speed of accomplishment grows geometrically in a parallel world where people at different levels work from the same standard/reference to advance a cause.
Normally people who don't understand an issue like to create models and present the slowest, most challenging and close to impossible option in an effort to "win" the argument.
It has been a well documented evidence that more than 20% of healthcare costs are related to administrative and data handling resources. Most doctors' offices are swamped by years of files and need an additional 30%-50% of space to store these paper traces. And, it is a known fact that people can't read all this information, misread it, mishandle it and the result often is wrong diagnosis, wrong care and medical errors that could kill a patient.
Standardizing medical data, digitize it and make it available in an intelligent manner can save more then 20%, can help our medical delivery system and can save lives! This is not a political issue but one of life and death!
How do you measure your pain? It is difficult. No lab tests or X-rays can convey to your doctor what you are feeling , it indicates findrxonline in his article about this topic.But even when pain is intense, many people struggle to find the words to describe it to the doctor. It is important to understand whether you suffer from acute or chronic pain.
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