Healthcare information technology garnered a large share of the industry spotlight in 2007, serving as the backbone of many initiatives from patient safety and quality to legislative and investment efforts.
Some of the most contentious issues in healthcare involve technology. Doctors are reluctant to buy expensive, difficult-to-learn electronic information-management systems when the benefit to their business is unclear.
Yet, technology is lauded as having significant benefits to patients who can manage their own records and clinical systems that can be operated more safely and efficiently, and states are behind efforts to incorporate more IT into healthcare facilities. Some big names found their way into the healthcare IT arena this year as well.
Over the past year, Health IT Strategist has chronicled some of the key issues affecting the industry. This is part two of a look at what readers found to be the most important in 2007, based on a review of page views for stories. To read part one, click here.
Electronic information management
Electronic health record, electronic medical record; tomato, tomahto, right? Not quite, in the healthcare IT world. When it comes to information management systems, terms have exact meanings to professionals. So much that the federal government has developed committees to define what is an EHR and an EMR as well as a personal health record, regional health information organization and health information exchange.
What the year presented was a view of the pitfalls in implementing patient data-management systems. While doctors are using computerized physician order entry to combat errors and mistakes in understanding handwriting, a number of unintended consequences resulted. The most surprising was an "illusion of communication" because providers no longer had to talk to one another when making entries, which led to an assumption that orders were received and understood, but no confirmation, according to the report in the Journal of the American Medical Informatics Association.
"I do the same thing with e-mails. I send one and assume the other person received it," said Joan Ash, an associate professor and vice chairwoman of the Oregon Health & Science University School of Medicine's department of medical informatics and clinical epidemiology.
There is a lot of frustration on physicians' parts when it comes to being told to implement EMRs, another unlooked-for result of electronic healthcare. Doctors participating in a session on "disruptive physicians" during the American College of Physician Executives' Spring Institute detailed the anti-social behavior popping up in the workplace. In addition to time and competitive pressures and sleep deprivation, transitioning to EMRs was named a reason some doctors are wearing T-shirts that state: "If you could read my mind, you wouldn't be smiling."
Information overload is another frustration, especially as patients begin to be more involved in managing their own care. PHRs are looked on warily by some doctors, who dread having to sift through years worth of raw data to find what might be useful in helping them treat their patients. PHRs are a potential liability, too; doctors could misdiagnose an illness if they miss information the patient gives them.
"In some ways, it's simply an electronic extrapolation of what we've seen in the paper world," internist Michael Zaroukian said earlier this year at the Integrating the Healthcare Enterprise Connectathon, an event that brings EMR vendors together to solve interoperability problems. "The greater the volume, the more likely it is that relevant data will be lost."
Physicians could be relieved then by a Harvard University report that showed EHRs are not necessarily associated with better care; however, EHR vendors were quick to jump on the study, and the age of the data used in the research.
The study's authors concluded that electronic records were being used as little more than paper replacements, and not as a tool toward improving quality. Vendors suggested that while that might be so, EMRs can be used to improve quality and they should not be discounted.
Full implementation of an advance-staged, sophisticated EMR can provide cost reductions and patient-safety improvements, according to chief information officers, and their report pointed to hard figures for a large, albeit hypothetical, hospital.
The goal of creating local electronic records is far broader: many proponents are working on networks of health information systems that can be exchanged across facilities, regions and states. Although RHIOs are struggling to prove their worth financially as 2007 comes to a close, at the beginning of the year healthcare officials touted those networks as interoperable, efficient additions to physicians’ practices. In particular, a one-vendor system designed to improve interoperability was introduced to entice physicians.
Governance
The federal government isn't only interested in defining the terms that dictate electronic information management, it would also like to establish regulations that guide IT implementation across facilities. However, the year was marked by several IT bill failures in the Legislature. The Wired for Health Care Quality Act, sponsored by Sen. Edward Kennedy (D-Mass.) and backed by a trio of other influential lawmakers,
failed in two attempts to get "hotlined" in November. In addition, a bill that proposes to give incentives to physicians for using computerized drug entries was submitted late in the year, but went nowhere.
Ironically, a recently passed $4.6 billion Medicare bill had no IT provisions included. CMS acting Administrator Kerry Weems, a proponent of EMRs, remarked on the bill: "We'll live to fight another day."
Privacy is a big concern in the endeavor, although privacy advocates say government efforts are weak and don't protect individuals. HHS was thrice rebuked by the Government Accountability Office for failing to develop a privacy policy for healthcare IT.
HHS' Office of the National Coordinator for Health Information Technology, the leader of nationwide health information network efforts, did unveil the beginnings of a privacy policy during an American Health Information Community meeting in June, but that framework ignored what another federal agency, the National Committee on Vital and Health Statistics, already had recommended. Since June, ONCHIT hasn't completed its privacy policy work.
Even the Health Insurance Portability and Accountability Act of 1996 drew fire for not sufficiently protecting confidential patient information. HIPAA has become a "
bureaucratic nightmare," according to one HITS reader. Participants who testified about HIPAA's adequacy
during an AHIC meeting in July divided along privacy advocates and data exchange advocates: privacy groups said the government does not have patients' interest in mind, while data exchange supporters believe they do not fall under the HIPAA regulation.
Vendors did not escape the privacy criticism either. Some companies creating EMRs have clauses in their contracts that would obligate providers to violate privacy rules,
according to internist Paul Tang, vice president and chief medical information officer for the Palo Alto Medical Foundation. Tang, who also participates in federal privacy efforts at NCVHS and AHIC, said there are currently no laws to require vendors to disclose those stipulations to consumers.
What IT story do you think had the biggest impact in 2007? Write us with your comments at [email protected]. Please include your name, title and hometown.
