Do you know what information is in your electronic health record? Do you have access to it right now, or is it locked up in a computer somewhere? If you fall sick or get injured while traveling in a state across the country, or traveling in a country across the world, what will those doctors and nurses be able to learn about your medical history? Many people cannot answer those questions, and for most of those who can, the answers would be “not really,” “no,” and “nothing.”
That is all about to change. The ways in which we record, transmit, analyze and make use of healthcare information are changing more rapidly with each passing year. The nation has made dramatic progress since the 2008 HITECH act established $30 billion in incentive payments to hospitals and physician practices. The program introduced health information technology into everyday practice according to a set of standards called Meaningful Use, which have upped the ante for health IT with new, more demanding requirements every few years.
Although the Meaningful Use program is controversial for its relentless pace of new standards and its high expectations that some say are not consistent with clinical reality, the program has been an indisputable success at its stated goal to introduce new health information technology systems into the vast majority of hospitals and doctor’s offices nationwide. For many practices and for some lower-resourced hospitals, the program ushered in electronic medical records for the very first time. The adjustment to new technology has not been smooth overall, but policy makers at the Office of the National Controller (ONC) for Health Information Technology are pushing forward with their bold – if not always popular – ideas. The evolving future state that results from their efforts will, at the very least, be fascinating and will transform, for better or worse, the relationship of all patients with the healthcare system.
Observers from across the medical, academic and health policy fields have explored this future. Dr. Robert Wachter is the Interim Chair of Medicine at UCSF Medical Center, past president of the Society of Hospital Medicine and in 2015 became Modern Healthcare’s #1 most influential physician-executive after publishing his latest book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. His view of the current state and potential future for health information technology changed during the course of writing the book.
“We were waiting for years for computers to fix the problems of medical mistakes, and they’re doing that to some extent, but they’re also creating other new hazards,” Wachter told Healthcare IT News in an interview earlier this year. However, he also stated that “…we can get to a really wonderful place – and we probably will – but we’re not there yet, and the path to getting there is what I was trying to explore.”
That simultaneous caution and optimism runs throughout the book, as Dr. Wachter explores the core debates in health information technology in a nuanced but conversational way: the evolution of the medical note from ancient times to the digital age, the practical problems all organizations encounter during “go live” technology upgrades, the age-old debate of whether computers can be adequate substitutes for human judgment, the challenges of making separate information systems talk to each other, how the patient’s role in the doctor-patient relationship is changing, and more. The book is not only a wonderful introduction for people who don’t know much about health IT, but also an astute analysis that will guide people who are on the forefront of change.
Those who are pushing for faster, more widespread adoption of next-generation health IT see a future where patient health information is available when and where it is needed, developed with equal power and input from the patient and doctor, and combined with health data from millions of other patients to inform better clinical practice and drug and medical device safety.
Although the current state of health information technology is far from that vision, it seems that healthcare providers and regulators are working together like never before to build and refine the processes and tools that will be necessary. In areas such as telemedicine and remote monitoring, technological advances have combined with updated regulations to allow innovation to spread, even within the established and often slow-moving healthcare delivery system.
With any major leap forward, the potential risks are apparent. Private healthcare providers and public agencies are being attacked and compromised left and right – the Identity Theft Resource Center has found that 100 million medical records have been breached so far in 2015. The record amount of data theft raises obvious concerns about the idea that more information will soon flow through these insecure systems.
Regarding the changing patient-physician relationship, some physicians and medical ethicists are concerned that clinical decision-making could become more uncertain and confusing if patients, who are by and large not trained clinicians, are given too much say in their care. Research from Accenture finds that 82 percent physicians want patients to be more involved in their care – but just 31 percent want patients to have full access to their health records.
Eric Topol, a prominent cardiologist at Scripps Health who has written acclaimed books such as The Creative Destruction of Medicine and The Patient Will See You Now, embraces the idea that patients will become empowered consumers of healthcare and have more influence over their care than in traditional models of the doctor-patient relationship. Topol declared in an interview with Elsevier that we are “rapidly approaching the end of the paternalistic concept that MD stands for ‘medical deity.’”
With this new future arriving fast, what are the biggest unresolved issues? The “EHR 2020 Task Force” of the American Medical Informatics Association (AMIA) issued a report in May 2015 that summarizes the major problems and provides five recommendations. The problems that the report identifies include reduced time for patient-clinician interaction, new and burdensome data entry tasks for clinicians, longer workdays, lack of system interoperability, and lower satisfaction with professional work life. The report suggests that we prioritize efforts around five pillars:
- Simplify documentation to reduce clinicians’ data entry burden and generate automated reports that are most useful to clinicians and patients;
- Refocus regulations to bring clarity around Meaningful Use standards, improve data exchange and interoperability, and place more emphasis on patient outcomes;
- Increase transparency and streamline the certification process for new health IT systems to foster more innovation and competition within the industry;
- Encourage health IT companies to open their closed-off systems through APIs that third parties can use to develop more integrations and enhancements;
- Support patient-centered healthcare delivery by incorporating the “full social context” that exists outside of the hospital or primary care office.
The report states: “Ultimately, our goal is to create a robust, integrated, interoperable health system that includes patients, physician practices, public health and population management, and support for clinical and basic sciences research.”
Based on all of the current concerns and unanswered questions, achieving that vision is easier said than done. However, there is no doubt that the world of health IT is experiencing dramatic change. If there will ever be an opportunity to create that future, it sits in front of us now.
NOTE: The views expressed here are those of the authors and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com
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