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Only connect—meshing home devices and electronic health records

I won't go into all 11 of the recommendations in a report this week from the National Research Council on improving the connections between electronic health-records systems and home health-care monitoring devices, and the usability of those devices by nonclinicians.

You can read them all in a free copy here.

But two key recommendations in the 203-page report, “Health Care Comes Home: The Human Factors,” were directed at the Office of the National Coordinator for Health Information Technology, and I'll deal with those two in this post.

Complaints about EHR user interfaces are as common as dirt, if not as old. And a lack of interoperability between EHR systems and anything else remains a vexing problem for health information technology users and promoters.

So, it's no surprise that the committee found room for improvement regarding both the usability of home health devices and their ability to link to clinicians' EHRs.

In fact, the committee's very first recommendation called on the ONC, which provides for certification of EHRs, to work with the Food and Drug Administration, which regulates medical devices used in clinical settings, to “regulate, certify, and monitor” those applications that integrate the two.

I spoke with David Wegman, the chairman of the NRC's Committee on the Role of Human Factors in Home Health Care, which produced the report. Wegman is a professor emeritus in the School of Health and Environment at the University of Massachusetts in Lowell.

“As it is now, the ONC has the responsibility for the credentialing and oversight for health information technology and the FDA over devices,” Wegman said. “The gap is when those devices are interconnected.”

Testing and certification of this interoperability function is likely to require something other than mere inclusion in the meaningful use criteria under the EHR incentive program of the American Recovery and Reinvestment Act, according to Wegman.

“It's not clear to me that meaningful use is the right cubby hole to put this thing in,” Wegman said. The requirements for interoperability between EHRs and home health monitors “are, in a sense, more narrowly drawn.”

Wegman and his colleagues also recommended ONC work with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, to set design guidelines and standards for home health devices “based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability …”

A couple of weeks ago, I brought home an Android-based smart phone and have since been climbing the learning curve on its use—as well as dealing with its dysfunctionalities. Thankfully, the Android wasn't first designed for use in a hospital or I'd have blood loss by now.

The technologies for several home health devices, however, were originally developed for clinical settings, are complex, and are only now being dumbed down for household use.

“The issue is,” Wegman said, “how well are those systems designed for use in the home. As a consequence, they may be misused or not maintained.”

You can follow Joseph Conn on Twitter @MHJConn.


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