When President Bush addressed the American Medical Association in Washington in March, he remarked, "Healthcare records are kept in different formats-believe it or not, a lot of times on paper." His choice of words implies that he can't believe any paper-based records remain. But the reality is that paper is an all-too-common form of health records in the 21st century.
Paper records have none of the characteristics we seek in an electronic health record. They are not standardized, accessible or connectable. They often are illegible, contain data discrepancies and do little to aid and guide healthcare decisionmaking. In short, they have become dangerous to our health.
The need to advance to a national health information infrastructure including electronic health records, personal health records and a robust public health information system is no longer a matter for leisurely cost-benefit debates. It is a matter of public safety. Moving healthcare into the information age is a national issue, an institutional issue and an issue for each of us as health professionals and as people.
Health information managers refer to today's record as a "hybrid" to denote its combination of paper, digitized and imaged information. Each provider organization has moved on its own path to the electronic health record at its own pace. To accelerate change, we need to find common paths that work. For example, a health information manager recently told me of her hospital's practice of printing a paper record and dumping digital information after patient discharge because the organization is reluctant to risk investing in a repository. Another professional tells of demands by attorneys for everything on paper because they don't trust the provenance of digital information. Experiences and results must be shared to accelerate the pace of change-and to overcome the fear of making costly mistakes.
In just more than a year, enormous advances have been made to establish consensus and deploy standards for data and communication connectivity. This has been done through unprecedented collaborative projects such as Connecting for Health, the eHealth Initiative, the federal Consolidated Health Informatics initiative, the National Alliance for Health Information Technology, the National Committee on Vital and Health Statistics and others. Embedding standards in our systems-and our culture-will take time, and the stakes continue to grow.
We need the will to move beyond standards for interoperability to advance standards for information content, controlled terminologies, patient identifiers and upgraded classification systems. For example, the U.S. now lags behind other developed countries in its use of a 30-year-old classification system called ICD-9-CM to code diseases and procedures performed in hospitals. This has a profound impact on clinical and outcomes research and payment and healthcare policies.
Getting to the electronic and personal health records requires investment in information and communications technology, but it also requires investing in developing people, processes and policies-in other words, leadership for the long haul. Process leadership has been very difficult in our segmented industry, as evidenced by the rate of patient errors despite the many starts and stops in quality improvement over several decades.
Policy leadership also has been difficult for healthcare organizations. Many have had policies on the books for years dealing with confidentiality of patient data and documentation practices. Yet we have had to undergo costly efforts to prepare for Health Insurance Portability and Accountability Act privacy regulations and to deal with fraud and abuse investigations. Many patient errors can be traced to failure to adhere to age-old documentation policies.
The electronic and personal health records will prompt new challenges. For example, health information managers agree that gaining consensus on what constitutes a complete patient record and what is and is not part of the designated record set is a top practice issue in the era of hybrid records. Standards for interoperability are critical, but staff training, job and process engineering and information policy must be pursued with equal vigor.
The challenges are daunting, but never before has there been such a level of public and private collaboration and determination to drive change. This must be sustained so that we don't mistake interim results with the finish line. The American Health Information Management Association has taken a position of supporting a national health information infrastructure and has called for the federal government, with full cooperation of the healthcare industry and Congress, to provide leadership, funding and oversight for the long haul.
We need to push change at all levels. For example, AHIMA has undertaken an electronic health information management initiative to accelerate the pace of change. We began by creating a vision of what health information management practice will be like with the electronic and personal health records and without paper records. This helps us set priorities for research, best practices and how best to assist our members in building a business case for technology and process change. It also allows us to understand future workforce needs and to advance academic education in the field to prepare professionals to manage without paper records.
Finally, we need to help people understand that quality information is important for health. Paper records and the status quo affect the cost of care, its availability, quality and safety, as well as the availability of new treatments and our understanding of the efficacy of alternatives. The status quo is dangerous to our health.
Linda Kloss is executive vice president and CEO of the American Health Information Management Association, Chicago.