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Looking Towards the Future: Health Information Technology (HIT)

Our health care system is broken. We pay more money as a percentage of our GDP than any other country on health care, yet we often rank poorly compared to other wealthy nations when it comes to quality measures.

One of the reasons that costs are high and quality is low is because we use 19th-century technology to serve a 21st-century health infrastructure. In addition to driving up administrative costs, our reliance on paper charts, pens, pencils, faxes and telephones leads to costly medical errors:

  • Between 44,000 and 98,000 individuals die each year due to medical errors.
  • Between $200-300 billion is lost due to medical errors, including misplaced tests and records.

As a result, lawmakers including Senators Barack Obama and John McCain argue that we need to update our health infrastructure by using digital technology to:

  • store patient data,
  • order prescriptions,
  • send medical reminders,
  • coordinate managed care plans,
  • monitor hospital procedures,
  • eliminate redundant lab tests and
  • improve assessment measurements.

In other words, we desperately need a nationwide Health Information Technology (HIT) system.

  • The research to support this idea is strong: One prominent study estimates that a fully functional HIT system would save up to $77.8 billion/year.
  • An HIT system also just makes sense. Anyone who purchases music through iTunes or pays bills online is already familiar with the increased efficiency that can come by using information technology. Why shouldn’t similar technology be available to health professionals?

The Need to Connect: What would an HIT system look like?

HIT promoters envision a nationwide, standardized, interoperable system based on Electronic Health Records (EHRs).

Cutting Costs and Improving Quality: What’s Involved?

  • Electronic Health Records (EHRs): EHRs are the most important part of the plan. Instead of having medical histories recorded on paper charts, all records throughout a person’s lifetime would be stored digitally.
    • Patient Control: To keep records private, patients would have control over which doctors or researchers could access their information.
    • Designing adequate privacy safeguards is vital to HIT. Many people fear that their medical records will be used against them by employers or insurance companies.
    • Whether the EHRs are managed by health providers or by separate data banks (which is one proposal), patients would own their own accounts just like they own their own bank accounts. They would be able to access their own records online and adjust the security controls on their file. They could select, for example, whether their information was shared with other doctors or with research organizations.
    • Keeping privacy controls up-to-date and in-line with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 promises to be an expensive and complicated task for any organization that manages EHRs.
    • Benefits: EHRs are currently used by 14% of health providers in the U.S. They help to cut down on medical errors due to illegible handwriting and lost paper files; at the very least it allows the entire office staff to communicate abouta partient’s treatment plan.When combined with decision-support tools, EHRs can reduce the time it takes a doctor to make a diagnosis or recommend a course of treatment.
  • Nationwide Participation/Network: Health providers nationwide, from single-doctor practices to large hospitals, would have to change to digital technology and Internet access at their locations. Labs, radiology centers, pharmacies, health care payers, and public health departments would need to participate as well.
  • Standardized Technology: In an information-rich industry like the health care sector, it is essential to commit to technology standards in any attempt to create an HIT system. There are a number of different ways to describe any one health problem or to record a measurement. If HIT systems do not use the same notations, they will not be compatible and it will be just as difficult to compare data as it is with paper charts.
  • Interoperable means the ability to talk to each other. Having providers, labs and pharmacies enter all records digitally is not quite good enough. By making the system interoperable, doctors in one place would be able to access the tests, treatments and records of doctors elsewhere through an online health network.
    • As hospitals begin to invest in HIT technology, time is of the essence in mandating national standards that guarantee interoperability between systems. Otherwise, we will end up with isolated islands of information that cannot be shared via the Internet.

With all of these components in place, we can imagine the following scenarios:

  • Imagine: You are hurt in an accident while traveling away from home and are rushed to the nearest hospital. Rather than waiting for you or your family to provide your vital medical history, the hospital quickly pulls up your health and insurance records on the Internet, saving time, money and maybe even your life.
  • Imagine: An FDA researcher is conducting a large-scale analysis of a certain drug. Instead of waiting for hospital records to be collected manually, the researcher gains permission to collect anonymous records through the HIT network. The researcher is then able to make a well-informed, timely decision about the drug.
  • Fact: Presciption errors are the most common medical error, harming up to 1.5 million people and costing $3.5 billion a year.
  • Imagine: Doctors sending prescriptions automatically to pharmacists, who are then able to read the prescription clearly. Pharmacists would also be able to check the script against a patient’s medical history to be sure that the dosage was correct and to check for compatibility with other medications being taken.
  • Imagine: A nurse digitally recording every time she gives a drug, and then receiving a beep or text message reminder when it is time to give the next dose.

The Department of Health and Human Services (http://www.hhs.gov/healthit/) also points to increased efficiencies that would come with:

  • Less reliance on paper, memory and telephones,
  • Improved quality of care with doctors comparing notes about a given patient through email (with permission of course)
  • Decreased costs for everyone due to less costly mistakes.

Value of the HIT System

  • U.S. industries use similar, information-rich systems: Just take a look at the banking sector. When you want to withdraw money from an ATM, you simply insert your credit card and your account can be reached.
  • Taiwan uses a similar card system for health care. Every patient is given a “Smart Card” which they bring with them to doctor’s appointments. The card is scanned and the patient’s medical history and records are pulled up. The cards reduce administrative costs because they allow doctors to electronically bill the government.

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