President Obama proclaimed this week (September 11 – 17, 2011) as Health Information Technology Week. The focus of the week is to educate people – physicians, policy-makers, researchers, and the healthcare community – about the value of health IT. The president encourages us to "learn more about the benefits of Health IT by visiting HealthIT.gov, take action to increase adoption and meaningful use of Health IT, and utilize the information Health IT provides to improve the quality, safety, and cost effectiveness of health care in the United States.”
But what is “health IT,” anyway?
Here’s the current reality: The most motivated patients keep large binders with their health information (copies of charts from various doctor visits, documentation of test results and prescriptions, etc). The rest of us, patients and physicians alike, stumble around with incomplete information at nearly every point – my most caring primary care physician can’t wrangle information from specialists if I haven’t told her where I’ve been; we all forget details of our OWN health and care, no matter how many times we complete a health history form; and keeping track of a relative’s health history too? Doctors “repeat tests” because they have to – often because it’s quicker to do the test again than to wait for prior results to be found, copied, and sent. All of us – from the healthy person who needs to see a new physician only because the old one doesn’t take the new insurance, to caregivers, to especially the chronically ill – realize how messy, expensive, and, well, inefficient we are. It kinda works – but we all know we’re each being underserved.
“Health IT” is the idea that the sensible application of technology can ease the pain.
Anyone with a web browser or smartphone has to wonder why it’s easier for Lending Tree to know that I owe Sears $317 than it is for my son’s pediatrician to know the results of his skin biopsy. For the former, I only need to provide basic information about myself. For the latter to happen, I need to make sure that Doctor A knows about Doctor B, and often I need to insert myself entirely in the transaction, paying to get a copy of the results, and hand-delivering records from physician to physician. I may be a pro-active, participative “health care consumer” – but there’s got to be a better way.
Health IT means using technology – digital medical records and ways to connect health information and people – to:
Improve the quality of care, by providing complete health information to those who need to know it, when they need to know it.
Enhance the quality of care, by providing guidance to physicians based on medical information (“clinical decision support”) and things like “ticklers” to doctors, patients, pharmacies, etc. when follow up is needed.
Impact safety, by using technology to check things that humans may forget (in a basic example, alerting a physician or pharmacist that drugs A, B, and Q shouldn’t be taken together, or shouldn’t be combined in patients with condition M).
Reduce costs, in large matter by reducing inefficiencies like multiple redundant tests, copying and recordkeeping costs, staff recordkeeping. Even simple uses of technology can make a doctor’s office more efficient, a hospital more efficient, increase efficiencies in the office, and reduce paper waste. Digital records can also be more secure - where "anyone" in your doctor's office could look at your record, an electronic record can keep track of who does.
Expand “access to care,” by finding a way to use technology so that doctors can treat patients effectively over the phone or the web, so that we can connect medical information, people, and physicians, regardless of where in the world they are.
Bioinformaticians and -statisticans, epidemiologists, researchers, and public health workers swoon about the potential power we can unleash together – from trends to better treatments to cures. One very small example is the cute story of Google’s ability to identify flu outbreaks based on search results – this is how powerful a lot of information can be. Imagine what answers can be found if that information is detailed and organized (standards-based and interoperable, in HIT terms) – can we identify a particular flu strain in your neighborhood and get you a specifically-tailored vaccine? What becomes of cancer clusters? What happens if a researcher can see what looks to be a correlation among people with asthma and people who have a particular genetic marker? I’m getting dreamy here, but isn’t it nice to dream a bit?
This seems like practical stuff. Some of it seems to be simple stuff – we can employ “telehealth” now with a call to our doctor. (But it’s harder with a physician across the country or the globe, isn’t it? – making that happen, that’s health IT.) “Health IT” is a made-up, inside-the-beltway term, whose definition is supposed to be grander than “health information technology.” It properly posits that technology has a place in making things easier, and better, in making a new reality around healthcare, treatment, research, costs, our dreams of translational medicine and better health. It’s not going to be easy – we’re going to see UHF and VHF and tubes and front-projectors and rear projectors and HD mini-projectors and Betamax and VHS and DVD and Blue-Ray and HD-DVD and Hulu and Netflix and iTunes – it will be a rocky path to stitch together medicine and people... and policy... and technology.
And these kinds of big visions are, frankly, the right things for government to realize through policy and force of will (such as the declaration of “Health IT Week”). After all, it’s the government – specifically in this case, the Office of the National Coordinator for Health IT – that can bring parties together – care providers, hospitals, insurance providers, government agencies, people – to set out a common understanding of what the desired destination is, and to help us organize around what steps we would be willing to take to get there. Getting from reality to vision is tough work – resourceful government workers in health IT view their role as listeners and enablers, working to help practices, hospitals, and states take baby steps toward the vision.
And it’s going to be baby steps. I’ve talked before about my fabulous endocrinologist, a highly-educated Washington “top doctor.” He doesn’t use an EMR and brooks no meaningful use – his focus is spending time with patients. But he uses a Palm Pilot-like gizmo to send my insulin prescriptions directly to the pharmacy. And he answers my emails. And has a website with relevant information. And he calls me with my tests results. That’s some fine health IT. Baby steps. So, happy “Health IT Week.” Here’s to maturity, growth, and wisdom as the years go by.
-Leslie Power, 5AM Solutions