SLA Biomedical & Life Sciences Division Blog: A Big Stimulus to Health Informatics That May Have Some Cart-Before-the-Horse Problems & Potential for Creating More Nationwide Guidelines to What Medical Practices & Procedures Will Be Allowed or be Reimbursable

As part of the American Recovery and Reinvestment Act, signed into law by President Obama, on February 17, 2009, initiatives aimed at increasing the use of Medical Records Informatics (or alternatively Health Information Technology, often acronymed as HIT) were funded at $19 billion. This is an astonishing increase over the Bush administration’s annual allocations of about $60 million.

It’s clear that we will be getting a lot more of it, but just what is it that we will be getting?

What is meant by medical informantics or HIT, is all over the map.

But the most common usage relates to the maintenance of factual information concerning a patient’s medical history that is basically held in a highly readable computer file, that is nonetheless encrypted to avoid unauthorized access, for ease in consultation by healthcare professionals during patient care.

This information typically would include all the personal information about the patient in terms of name, address, age, marital status, number of children, medical insurance, as well as more clinical details such as blood type, blood pressure, weight gain, smoking history, history of substance use and abuse, prior illnesses and surgeries, prescription medicines being taken, dates, purposes and outcomes of earlier hospital admissions, and especially results of ongoing laboratory tests and x-rays for the condition currently under treatment.

The strength of a good medical informatics system would be that doctors and nurses and other healthcare professionals would be able to enter progress notes and be able to find the inputs of their colleagues, so as to treat the patient better, particularly in a coordinated manner that does not have people working at cross-purposes.

This sounds like it should be pretty straightforward technology that is so self-evident in its worth that it should already be ubiquitous, but only about 10% of doctors and hospitals have these systems already in place, and there are many different, and sometimes financially shaky providers pitching their particular unique system.

What may be worse is that while these individual systems work very well within a particular hospital network or group medical practice, there is as yet no guarantee that the records will load seamlessly into the electronic files of another system used by another doctor or hospital system.

This is not an impossible goal for the future, and has certainly been done before in the financial services industry, and in chain-of-supply management in engineering, and the federal government is forming a standards commission to make it happen at some point.

The problem is that this patient records informatics commission will have two different goals that may not operate on the same timeline to decide on what constitutes a successful system, and when the competing technologies are ripe for consensus rulemaking on interoperability.

Under the new funding rules it appears that patient record informatics projects will receive serious funding only to the degree that they can be shown to be already successful, and in particular, that they represent a real improvement over existing paper files or mixed paper and electronic files.

The measures of success will be demonstrations that the new electronic records help staff avoid iatrogenic errors like prescribing the wrong medicines, operating on the wrong limb, pursuing a course of treatment taken that would be inadvisable given prior medical history, and basically that tests or x-rays would not have to be repeated just because no one could find the original results.

Again this all seems sensible, but the hospital or the doctor basically has to invest a great deal of its money first, and in essence bet that their chosen system will not later become obsolete, or eventually be declared nonstandard by the later adoption of data encoding methods or file sharing schemes which can be accommodated only by the winners in a later war of competing conventions.

In other words a commission could have, by way of analogy, decided that at one point Sony BetaMax was going to be the best system for delivering video, only to have to revise their thinking when they found out that what the market really wanted were DVDs, and having redone regulations for that , find later that Blu-Ray was so technologically superior that they would have to do it all over again.

Such a cycle would leave a lot of hospitals and medical office practices in a medical informatics creditability & credit crunch.

Nonetheless, there is no serious opposition to the fundamental idea of this Medical Informatics initiative, and it has received a great deal of initial support and enthusiasm.

Nor since the vigorous monitoring and enforcement of guarantees contained within Health Insurance Portability & Accountability Act (HIPAA ) legislation, does it appear that the privacy issues of individual electronic patient records will loom large as a concern.

The sleeper issue appears to be the incorporation of cost-of-medicines, cost-of-diagnostic-tests, cost-of-procedures, cost-and-duration- of-hospital-stays type of information that can be retrieved anonymously (so as to guard an individual patient’s privacy) but then bundled together in the hundreds of thousands to set federally-mandated cost-containment policies, once patients records informatics interoperability has been achieved.

This has already been happening on a smaller scale with many private insurance companies in terms of what they will reimburse hospitals for given Diagnostically Related Groups of Illnesses (DRGs), focusing primarily on length of stays, and with doctors, focusing on what portion of their fees will actually be paid, and similarly for pharmacists, setting not only what portions of their charges for drugs dispensed to patients will be reimbursed, but whether or not, a particular brand-name of drug must be paid for at all, when a generic is available.

Tony Stankus [email protected] Life Sciences Librarian & Professor

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DoBias, M. (2009). Ready to go. Obama, Congress, move fast to help hospitals. Modern Healthcare, 39(4), 8-9.

Solovy, A. (2009). E-health windfall? Obama plan to invest in health care IT means hospitals must do their homework. Hospitals & Health Networks / AHA, 83(1), 21, 2.

Waldrop, M. M. (2009). Obama appoints first federal IT chief. Nature, 458(7235), 136.