Trying to get your arms around health information technology is nearly impossible.
The technology itself is undefined. The players are untrained. But the potential for reducing medical costs and saving lives that otherwise may be lost to medical mistakes is undeniable. And Spokane has a head start.
The issues that health information technology (HIT) could address are wide-ranging: U.S. health care expenditures have grown every year for the past 60 years, while health care productivity has fallen behind spending. It’s been estimated that between 45,000 and 98,000 people die from medical mistakes each year. And other research shows that perhaps 30 percent of health care spending is for treatments that may not improve a patient’s health, may be redundant, or may be inappropriate for the condition.
Studies have indicated that technology tools, including the use of electronic medical records, could produce substantial improvements. It’s possible that lab and radiology testing would be reduced by as much as 14 percent, for example, hospital admission fees would be reduced by 2 percent to 3 percent and excess medication use would be reduced by 11 percent.
Those potential benefits prompted the U.S. government to step in, arguing for a better technological standard for the health care community. Last year, President Bush called for the nationwide adoption within a decade of a synchronized electronic health records system, and he included $125 million in seed money in his 2006 budget toward that effort.
A central component of HIT is the electronic health record, which is a digital collection of a patient’s medical history and could include items such as diagnosed medical conditions, prescribed medications, vital signs, immunizations, lab results, and personal characteristics like age and weight. This information would allow physicians and hospitals to exchange up-to-date medical data.
HIT has four main goals, according to the federal government:
• Inform clinical practice: Bring information tools to the point of care by investing in electronic health records systems in physician offices and hospitals.
• Interconnect clinicians: Build an interoperable health-information infrastructure, so that records follow the patient and clinicians have access to critical information when treatment decisions are being made.
• Personalize care: Use HIT to give consumers more access to and involvement in health decisions.
• Improve population health: Expand capacity for public-health monitoring and quality-of-care measurement and bring research advances more quickly into practice.
Tom Fritz, chief executive officer of Spokane-based Inland Northwest Health Services, acknowledges that the adoption of HIT will be expensive.
“The dollar amounts are going to be very, very significant,” he says. “The penetration rate for doctors and hospitals using electronics right now are very, very low. The high end is about 30 percent of acute care hospitals. That’s not a lot. When you think about the remaining 70 percent of the hospitals, you wonder who is going to pay for (the purchase of their IT systems), then you think about the doctors — there’s a lot of concern.”
Still, in-roads have been made locally. “The field is still in flux, and there is a lot of positioning for model programs. However, the only company that is identified in (a recent Rand Corp. report) was INHS,” Fritz says.
In the early 1990s, INHS — a joint undertaking of Spokane’s two big hospital operators — began working with local physicians who collectively decided that there was a big need to share clinical data. The original architecture was designed to share data among hospitals using the same Meditech system. Since then, INHS has worked towards data standards that would allow hospitals using other systems to share electronic health records.
Michael Smyly, the director of information systems at INHS, attributes the recent national attention to the organization’s advanced clinical systems, which include patient safety systems, bedside electronic documentation, computerized physician order entry and advanced monitoring systems.
He adds, “Our infrastructure and expertise has allowed us to move more quickly than many healthcare systems that are still working on systems integration and system stability issues. These are very important, and if we had not dealt with those issues early on, we would be stuck trying to make our systems work.”
Fritz adds, “We have been doing things that are ahead of the curve. And we did it for the right reason. That’s always been our goal. To ensure that we are doing the right thing for the patient and that the patient is getting the best clinical care.”
Despite the federal government’s hope, 10 years may not be long enough for all rural communities and outpatient practitioners to adopt electronic health records. In those instances, the costs may simply be prohibitive.
Still, those involved in HIT agree that the transition to electronic recordkeeping will ultimately benefit everyone and that it’s just a matter of time before there is a ubiquitous system. Maybe the rest of the nation merely needs to follow INHS’ lead.
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