Information is like water. Getting enough is essential, but a flood can leave you drowning in data. The volume of information flowing through the average medical practice has already risen to test the limits of traditional paper, fax and dictation methods. Now a tide of aging baby boomers needing healthcare threatens a new deluge. Medicine itself is changing, increasing the need for more robust information technology. The NIH is moving research toward a translational model, using informatics to create a closer link between the lab and clinical care to speed the benefits of new insights to the bedside. However, electronic logjams are keeping Healthcare Information Technology (HCIT) from reaching its full potential. These barriers to information flow cost providers time and money, and leave patients to face unnecessary risks. Because providers are often unable to exchange information electronically, the same basic patient data has to be input or recreated when a patient enters a doctor’s office, visits a specialist, or goes to a testing facility, a hospital, a nursing home, or a pharmacy. In emergency rooms, physicians may have to make critical decisions with no way of determining whether unknown medications or conditions might have lethal consequences. In an ideal world, an access code carried by the patient could pull up basic data, histories and medications to give physicians a complete view of factors to consider in planning treatment. A National Priority The American College of Physicians is urging collaboration on electronic healthcare information technology, and The White House has even appointed a czar to speed the movement to electronic medical records. At the Healthcare Information and Management System Society’s annual Advocacy Day in Washington a few weeks ago, I/T professionals met with congressmen about pending legislation to smooth the way for more efficient use of technology. However, before information technology can better serve patients and providers, several key problems need solving. Clearing The Log Jam One issue in getting providers on the same page electronically is compatibility. “Physicians offices and hospitals use many different types of software from many different sources,” said George Salem of Proxsys, a Birmingham I/T company. “To exchange information, they are likely to need an interface, or to be working from the same standards. Security is another issue. With HIPAA, patient privacy has to be protected. Set up properly, an electronic file can be more secure than a faxed file anyone might be able to pick up and read. However, you’re going to need strong protection from online intrusion.” A standard that is gaining national acceptance is called Health Level Seven (HL7). “People are asking about HL7,” said Matt Price of Huntsville-based FlexMedical. “Hospitals and physicians offices in Alabama are using it to exchange clinical, financial and administrative data. Interfaces also allow physicians to use their electronic medical records (EMR) systems to exchange data with labs. Some systems can receive test results, put them in the right patient’s file and let the person who needs to see them know they are there. It’s also bi-directional and makes sending requests to labs easier.” The most challenging bottleneck in HCIT, however, is found in primary care, where patients first enter the healthcare system. “With cuts in reimbursement, primary care physicans are having to see more patients in less time,” said Reuben Buckareff of Pensacola-based Blink M.D. “Some physicians have put thousands into systems they don’t use because they just can’t spare the extra two minutes to enter information. Dictating is faster for them.” Down the data stream, this affects other providers. “One of the larger specialty practices I work with in Birmingham has a terrific EMR system, and when they finish a case they have wonderful electronic records they can send back on patients they may not see again,” Buckareff said. “Their concern is that they aren’t receiving electronic records with referrals. It’s a time consuming effort just to replicate the same information the patient’s other physicians had to gather. Buckareff is currently working with artificial intelligence engineers from NASA to create new information tools that he hopes will work faster and learn to anticipate the physician’s workflow. Some EMR systems already allow fax prescribing, and e-prescriptions offer the added advantages of requiring no fax paper and alerting pharmacists to let them know the prescription has arrived so patients won’t have to wait. New systems also have decision support tools, including dosage information, updated advisories, and automatic alerts for potential interactions and allergies. Forecasting The Future In June, the Office of the National Coordinator for Health Information Technology released a strategic plan for 2008 through 2012 outlining federal efforts to move HCIT forward. A copy of the plan is available on the Health and Human Services website, www.HHS.gov/healthit Medicare has announced plans for a demonstration project at 12 test sites that will offer incentives for physicians to use electronic health records. There are also several bills pending in Congress. “The Wired For Healthcare Quality Act would create a foundation for a nationwide system, and it probably has the best chance of passage,” Buckareff said. “Representative Patrick Kennedy is also sponsoring the Personalized Health Information Act, which would promoted the use of secure, transportable personal health records.” July 2008