Mature Market Experts: more mature market news and stats more often – Why healthcare information technology should matter to you (part 2) - In my last article I discussed the benefits that health information technology could offer in relation to home health and, in particular, the experiences I had with my father when he was alive. Continuing on that theme, I would like to take some examples from my experience and demonstrate how certain key innovations could have made management of chronic ailments much easier for my father and for the family in general.

One of the chronic ailments that my father suffered from was the wet (or neovascular) form of macular degeneration. Neovascular macular degeneration affects about 10% of those patients who suffer from macular degeneration in general[1]. While there currently is no means of stopping or reversing the effects of macular degeneration, certain therapies (laser photocoagulation) can stem the bleeding associated with the wet form of the disease.

The effects on my father were heartbreaking in many ways. In my father’s working life he was a writer and editor for a number of industries, including the New York Medical Society, Ford Truck Times Magazine, and he was an advertising executive back in the 60s at J. Walter Thompson advertising as well as having his own advertising agency in the 1950s. In summary, my father’s sight was key to his livelihood. This was a man who used to read the New York Times cover to cover almost daily. In the last 5 years of his life, as a result of this ailment and the stroke he eventually suffered, he was left sightless and unable to enjoy the one thing that truly gave him pleasure.

I’m certain that many of us have equally poignant stories. During the 5 year period of both chronic and continuing medical care my father required I spent a great deal of time running him from specialist to surgeon to primary care physician to therapy and back again. I recall very vividly having to run him into Philadelphia from his home in the suburbs—about a 60-70 minute drive—for the purpose of having his eye surgeon review his progress. I remember how stressful the situation used to be: it was a fairly major production getting him out of the house and driving him down and back as he required assistance due to limited mobility. Oftentimes the visits were merely checkups of no more than 5-10 minutes duration. It was at these times that I used to ponder whether having a remote video and picture taking capability could have accomplished precisely the same thing: if his surgeon had the ability to review a photo remotely, my father could sit in the comfort of his home and have a retinal camera that I or another care giver could use to take a picture of his retina which could then be transmitted and reviewed by the surgeon remotely. Then, the visit could have been accomplished through a telecommunication session, in which the surgeon could speak with him directly over the telephone while reviewing the image. This would provide context for the imagery as well as provide for a much less stressful environment for my father.

Recently, Healthcare IT News reported “remote monitoring not only saves unnecessary trips to the emergency department, but prevents readmissions to the hospital.”[2] Unfortunately, the same article reports “healthcare payers are resistant to providing reimbursement for remote patient monitoring.” A chief reason for this seems to be the fact that the payer-provider reimbursement model is not adequately structured to take advantage of the benefit.

It would seem to me that the use of the technology would reimburse itself. Ignoring the time spent in traveling to and from the surgeon’s office, consider the fact that the visit itself could be shortened and accommodated on a schedule that could make most effective and efficient use of both parties: patient and provider. For example, a virtual office visit could be held at any time during the day (not just during “normal” office hours) and could even be managed from the provider’s home office. Of course, key to this would be the availability of a patient record in which information could be securely uploaded (e.g.: retinal imagery). A personal health record could have served this purpose. Furthermore, the relaxed setting of the patient’s home would have enabled a much more relaxed environment for the patient.

While the scenario I have described is not unique, it serves to illustrate a broader need and provides a compelling motive for telehealth and telecommunication. By linking healthcare information technology with existing means for communicating over telephone lines it is possible to achieve ends that will ultimately benefit chronically and elderly patients. In the next installment, I will address the benefits for other diseases, including stroke and glucose, and how the case for healthcare information technology has real benefits for the home-bound or chronically ill patient.

[2] Bernie Monegain, “Remote patient monitoring improves outcomes for chronically ill, study shows.” Healthcare IT News. March 24^th, 2009.

We are all familiar with visiting a physician office for the first time. You know the routine: you are handed a clipboard containing half-a-dozen pages or so in which you must disclose every torrid aspect of your life. You must hand over your insurance card so a copy can be made and you must list every medication, every tablet, every vitamin you take in quantity, type, label so that THIS physician has a clear picture of who you are and what has ailed you. Some people are more organized: they make copies of this information and merely re-copy onto the forms so that they do not have to make up their stories out of whole cloth. Others are not so organized. Regardless, this information is normally maintained by your primary care physician (PCP) and is seldom shared unless you explicitly ask for records or, perhaps, your PCP is one of the more “progressive” types using an in-house electronic medical record system. Alas, currently only a relatively small number of U.S. physicians make use of health information technology. The estimate is that 17 percent of U.S. physicians and between 8 and 10 percent of U.S. hospitals employ health information systems in the form of electronic medical records for capturing and maintaining patient medical data (David Blumenthal, 2009).

However, consider having to repeat this process for each physician you visit. This takes me back to the story of my father. My father, who passed away last August, had a stroke in 2003 at the age of 85. I’ll save the experience of the basic medical challenges for another article, but I will relate that the treatment process involved half a dozen specialists and allied health professionals. All of these individuals required similar information regarding his health and history. Each one of them required the information in a format similar to the method described above with clipboard and pen.

Let’s consider for a moment an alternate method for the requisite “data transfer” experience described above. Suppose that my father’s history, medications, allergies, treatments, etc. were all contained on a single “device,” such as something having the form factor and function of a Universal Serial Bus (USB), or memory, stick. Then, if each physician and specialty practice had the capability of reading such information from this device into an electronic record that employed common interfacing and formatting so that the information could be populated in a way that would be visible and accessible to each physician, a number of benefits would have resulted. First of all, the mere physical act of copying the same information over and over would not have been required. Secondly, the likelihood of inaccurately entering information could have been avoided. Given the fact that I was the primary source for data entry, I can attest to the fact that I am error-prone! Thirdly, having a complete and accurate list of his medications, his treatment plans, clinical notes, and orders all available would have provided to each specialist a comprehensive understanding of his history. This would have enabled each of them to communicate more effectively to determine how best to treat him without having to ask redundant questions of both him and me during the visit—more time could have actually been spent in treatment!

The capability and benefits described above are not out of our reach. The technologies exist to enable the scenarios described above. The benefit to patients is obvious, as can be discerned from even this simple telling. Improving healthcare delivery can be achieved without bringing rocket science to the practice—we can begin simply by doing what we currently do more efficiently and by bringing some good sense to the practice. We as citizens think nothing about going to a store and using a credit card to pay for goods and services. Yet, we have nothing equivalent in standard practice that allows us to treat the most precious good: our bodies. In the coming weeks I hope to expand upon this theme and raise awareness on the benefits of information technology and its benefits to healthcare.

Mature Market Experts: more mature market news and stats more often – $20B For Healthcare Information Technology - All politics are local, so the saying goes. So, it is worth noting that the amount of money being allocated in the new recovery and reinvestment law will affect all of us in some way on a local level—either for the good or the bad. Of particular interest to me is the roughly $20B allocation associated with healthcare information technology. As healthcare and its peripheral topics are of interest to me by education, training and profession, this particular expenditure carries with it both hope and caution. The expenditure carries hope from the perspective that the promise of universal electronic medical records can ultimately improve the quality of care for us all. The caution is that the devil is in the details and there is the possibility—and likelihood—that the challenges associated with implementing and administering such a technological advancement will not be resolved for many years to come.

Returning to the “politics are local” theme for a moment, the challenges with universal health records (note: NOT universal health care…I’ll leave that political debate alone for the time being) are in their implementation and acceptance across the U.S. It is not sufficient to simply supply each primary care provider with a laptop computer…there is the issue of the medical record software itself. Both Microsoft and Google have made large investments in personalized health records (I have one myself). But access to these data, the adoption of the medium across the country, identification of the patient, securing and protecting the information from unauthorized review, and many other challenges are before us.

These challenges will not be resolved by merely spending ~$20B on healthcare information technology initiatives. To address these challenges requires a unified effort across multiple fronts, including breaching technological and sociological boundaries. The basic tenets of restricted and assured access as well as accuracy of the data are so significant and are of such dire import that their mentioning cannot be overemphasized. From an academic perspective one might conclude that “of course” these items and more must be guaranteed. However, we in the U.S. have at present no common standard for enabling and ensuring these two most basic of operational items in this day and age. Certainly the technologies exist to meet the demands of these key requirements. But, their seamless, universal application is presently not available nor enforceable throughout the continuum of care nationwide. This is so for many reasons. Key among these reasons is the lack of enforced standardization for interoperability among the many, many standalone healthcare information technology systems. Many lone islands are available which cannot communicate among one another. The investment required to achieve this feat is in no way trivial. Furthermore, common standards for storing this information so that it may be retrieved at a hospital, say, in Orlando, Florida while I am away on business, have yet to be put into place.

So, how do we proceed? Well, in order to achieve the vision, all hospitals that acquire new or upgrade existing healthcare information technology systems (inclusive of electronic enterprise health records) should mandate that these systems interoperate with each other so that orders, medications, patient vital signs, laboratory results, imagery, and other information can be shared seamlessly among the many disparate systems that can coexist within a healthcare enterprise. This implies that such systems must support common data and information communication frameworks such as those proffered by Health Level 7 (HL7), DICOM, and others. Furthermore, such systems must provide the capability to support role-based user access to all stored information so that patient data will only be revealed to individuals with a need to know. Special care must be given to any information such as patient data for numerous reasons including safety and privacy. Additionally, repositories of patient information must be made available to clinicians anywhere at any time. Access must be reliable, assured, the data must be accurate and beyond question in terms of its integrity.

The aforementioned requirements are only a subset of those needed to support a truly universal form of electronic health record throughout the many thousands of enterprises worldwide. I have not made mention of the standards of care and how these can vary worldwide. Even if such a universal medium for storing and accessing patient information were confined to the United States alone this is a nontrivial challenge. However, I believe it is necessary to overcome given the even greater challenge of improving the quality of healthcare and reducing its ponderous costs in the years to come.

Note: more blog entries on electronic medical records can be found here.