Future of Health IT: Trends and Scenarios

Congress may seed integration of U.S. Healthcare/Patient Information Technologies

Via another FierceHealthIT article, I found this story on HealthDecisions.Org: Gordon Begins Effort to Integrate U.S. Healthcare/Patient Information Technologies. Another acknowledgement of our crying need - will it go anywhere?

U.S. House Committee on Science and Technology Chairman Bart Gordon (D-TN) has introduced legislation authorizing the National Institute of Standards and Technology (NIST) to establish guidelines and mechanisms to promote the integration of the healthcare information enterprise in the United States.

"The U.S. boasts the finest healthcare system in the world, yet doctors and patients still don't have access to comprehensive health information. Healthcare is the fastest growing sector of the U.S. economy, but it's also the only major sector that hasn't fully integrated information technology," said Gordon...

The adoption of electronic healthcare records and other health-related IT has been slow. In general the health care industry invests only about 2 percent of its revenues in IT. Other information intensive industries, such as financial services, invest approximately 10 percent of revenues.

"Current federal efforts have made slow progress in this arena and in this age of rapid technological advancement, that's unacceptable. This bill, and the development of interoperability specifications, is the logical first step in deploying and utilizing IT in our health system," said Gordon.

Physicians at EMR "tipping point" - FierceHealthIT

Here's a quick bit of good news for the CCHIT folks, who are working to stimulate EMR adoption in the US. From the FierceHealthIT Newsletter, word about a study indicating the possibility that the nation's physicians are at an EMR "tipping point".

Over the past year, study after study has documented that physicians aren't investing heavily in HIT upgrades, particularly EMR systems. But a new study suggests that the tide is about to turn. Researchers with Manhattan Research surveyed 1,353 physicians this year and found that about 30 percent are using EMRs, including not only the larger, better-capitalized finances practice but also smaller medical groups. Another 20 percent reported that that they were "ready" to adopt, the analyst firm reports. What's more, the number of physicians who interact with patients via e-mail is growing, hitting 31 percent this year as compared with 24 percent in 2004.

The study referenced can be found in this Digital HealthCare & Productivity article.

Child suicide rise tied to FDA warnings - FierceHealthcare

Another quickie, this one some troubling news about the controversy over antidepressants for children: Child suicide rise tied to FDA warnings - FierceHealthcare.

New research from the CDC suggests that after 10 years of decline, suicides by adults and children under 20 have risen substantially over the past few years Researchers say the trend could be tied to a drop in antidepressant drug use. The increase in deaths coincides with an FDA decision to put warnings on prescriptions warning that antidepressants could cause suicidal behavior in children.

Some mental advocates, including psychologist David Shern of Mental Health America, said they found the newly lethal trend to be "a disturbing reversal of progress." He also noted that other studies have shown a decrease in suicides related to antidepressant use.

Intel Takes Center Stage at Aging Conference

This is really from last week, but I'm just beginning to get caught up on draft posts. CIO Insight had an article about Intel chairman Craig Barrett's keynote at last week's White House Conference on Aging: Intel Takes Center Stage at Aging Conference. It's only one of several appearances Intel made at the conference; it's clear the chip giant is expanding its scope into healthcare IT in a big way.

At the fifth White House Conference on Aging, held this week and occurring only once a decade, technology took center stage for the first time.

Not only was the incorporation of technology into senior's lives among six guiding principles for the conference, but Intel Corporation chairman Craig Barrett provided a keynote speech for the event.

In his speech, Barrett urged U.S. government leaders to seize the opportunity to apply technology to help solve the economic and social challenges faced by the country due to skyrocketing healthcare costs and a growing wave of aging citizens.

Of course, any attempt at solving the above-listed problems faces some economic and social challenges of its own. Or is that the understatement of the millennium, at least with respect to US health policy?

More EHR products get certified, and I become a convert

CCHIT recently announced the second round of Certified EHR Products, bringing the total number to 33. This is great news. I'm curious, though about the use of the word "evolve" in this excerpt from the press release:

The certification criteria have been developed to ensure that products provide a broad foundation of functionality, will evolve to deliver standards-based interoperability with other systems, and include security features to protect the privacy of personal health information.

Oops. I thought we were doing this to achieve interoperability in the first place. One of the goals in CCHIT's About page reads: "Ensure interoperability (compatibility) of HIT products ".  It turns out that is in the future, and it's not clear when interoperability standards will be delivered.

Forget all those things about being skeptical about interoperability with respect to CCHIT's efforts (for example, see CCHIT EMR Certs: The Prisoner's Dilemma Revisited). CCHIT is starting from a different Square One than I was assuming, so at least some of my complaints are off-target. My bad.

QUICKIE: Internet2 report says funding mechanisms work against creation of research IT infrastructure

From the folks at internet2: Final Report: A Workshop on Effective Approaches to Campus Research Computing Cyberinfrastructure.

This is from back in July, but the link just got re-sent to me yesterday, and I hadn't noticed it back then. The report's analysis and recommendations are not specific to clinical research or even to biomedical research, but are still very relevant to our world. Between the advent of the genomic/proteomic/metabolomic era and its petabyte-level data storage requirements and the introduction of HIPAA Privacy and Security regulations, the need for a state-of-the-art, reliable, secure IT infrastructure in biomedical research is becoming mission-critical.  As I have noted before, the barriers are mostly non-technical, but instead related to issues of financial incentives, organizational culture, and human nature:

Major negative reinforcements exist in the current environment. For example, grant solicitations at several major funding agencies seem to favor "autonomous, small clusters in closets" over more sustainable and secure resources. Personal lambdas are sought by scientists less for their performance needs than to obviate the "friction" of campus network security. Lack of coordination of Institutional Research Boards (IRBs) creates major obstacles to inter-institutional data collaborations. Campuses may be legally liable to continue to provide services that were committed to by researchers who have since left these institutions; such situations can dissuade a campus from future commitments.

"Lambdas" are light frequencies, and refer to reserved bandwidth on optical backbones such as those used in Internet2 implementations such as the Abilene network.

eWeek Survey: Few Doctors Use Electronic Records, Fewer Use Adequate Systems

eWeek ran an article about a "survey of surveys" of EHR usage in the US recently conducted by the Institute of Medicine: Survey: Few Doctors Use Electronic Records, Fewer Use Adequate Systems.  It was also mentioned in Government Health IT in an article titled Doctors' use of EHRs may have been overestimated, study finds.

From the eWeek article:

...the study singled out one particular survey, the National Ambulatory Medical Care Survey, as particularly reliable. This is an annual, government-funded, nationally representative survey of all ambulatory visits to physicians whose practices are not hospital-based. It puts EHR use at 23.9 percent, but said only 9 percent of EHRs incorporated at least four of the functions recognized as key.

This helps to explain the low quality and high cost of US healthcare. Is there a solution?

Round Up the Usual Suspects: CTSA awards announced

The first twelve Clinical and Translational Science Awards have been announced. A few mild surprises, but really it's just a list of great clinical research institutions. It's not a comprehensive list, but a good start. Congratulations to all of you.

New interim coordinator for ONCHIT

The FierceHealthIT newsletter has an article today entitled Kolodner named interim health IT coordinator. Robert Kolodner has been the chief healthcare informatics officer at the VA until recently. HHS replacing Dr. David Brailer with Kolodner as head of ONCHIT is good news - I hope.

Is HIPAA enforcement finally growing fangs?

FierceHealthIT is looking at HIPAA compliance in two recent posts:  Is HIPAA enforcement finally growing fangs? and a bit earlier in Are HIPAA compliance efforts lax?

The HIPAA Enforcement Rule looks pretty vague to me, but then, I'm not a litigator. What's really interesting is learning that enforcement is passive: wait for the complaint to come in, then investigate. I have to say I'm really happy the meat industry isn't regulated that way. But then, food poisoning is a matter of life and death; having your identity stolen merely makes your life a living hell.

Oh wait, I forgot. The meat industry's regulators don't do much better. So if you happen to be the unlucky type, you could get your identity stolen while you are in the hospital being treated for necrotic enteritis caused by Clostridium perfringens hanging out in your steak tartare. I think it would be fair to call that a bad day.