Tuesday, March 30, 2010

Health IT Strategic Framework – Field of Dreams

Health IT is on a binge. Every day we are served with a new acronym, a new committee, a new contract, a new grant and a new goal. Health IT is definitely creating jobs, which was indeed one of the goals. But there was one other stated goal.

It was supposed to help physicians and patients provide and obtain better health care by making pertinent information available at the point of care, by involving patients and their families in their own care and by using computers to improve accuracy of clinical information. It was supposed to benefit patients in a very immediate and tangible way. That was the original meaning of the over used term “patient centric”. It was supposed to be all about the individual patient.

There were secondary goals as well. A byproduct of computerization of Medical Records is, of course, the ability to conduct research to benefit populations and advance the science of medicine, but somehow, in the frenzy of spending federal funds, the byproduct became the main objective.

I am a big fan of Dr. Blumenthal and in perpetual awe of his work at ONC. Today I read the recently published Health IT Strategic Framework. The ONC’s articulated vision, which drives the entire framework, is the creation of a “learning health system”. An excellent vision to be sure; a vision which drives a framework of security, privacy, biosurveillance, data collection public health, medical research and reporting. I have no doubt that in due course, such learning health system will produce evidenbe based information to support cost effective care and benefit future generations of Americans and humanity in general.

How do you build such a learning health system? It seems that ONC is tackling the task head on, by actually building a system from the ground up, complete with a National network (NHIN), localized intermediaries (HIE), individual access points (EHR), education centers (HITREC), standardization (Meaningful Use), certification (NIST, NVLAP, ONC-ATCB, ONC-ACB, ONC-AA), all driven by rulemakings and generous financial awards.
This is the “Field of Dreams” theory (If you build it, they will come), and it does work sometimes, as Kevin Costner can attest.

We could of course try a bottom up approach.

Case 1. 60 year old John Doe presents at the ED with chest pain. What does the attending physician need as far as information is concerned? A good current medications and allergies list and a good current diagnoses list and a little time to listen to John and take a good history of present illness. What does the attending physician not need? John’s growth charts from when he was a baby, John’s immunizations records from high school, John’s record of taking antibiotics for an STD while serving in the Navy 40 years ago, John’s record of taking other antibiotics for a sinus infection 5 years ago, etc. It would be nice if the attending doc could “get online” and download a couple of paragraphs of information from John’s PCP.

Case 2. 55 year old Mary Doe has Diabetes and Hypertension and CAD. She is sitting across from a Cardiologist who is seeing her for the first time. What does the Cardiologist need in order to evaluate Mary? Pretty much the same information the ER attending needed, plus any pertinent test results that her PCP might have ordered. And just like the ER attending, the Cardiologist needs a little time to listen to Mary. Most likely Mary’s PCP already faxed the information over. It would have been nice if the PCP information would “magically” end up in the Cardiologist’s chart and the Cardiologist consult note would end up in the PCP chart. It would also be nice if Mary’s daughter could “get online” and look at everything the doctors are doing, or proposing to do, because Mary may want to discuss her options with her daughter who lives 1000 miles away.

Turns out that patients and doctors can pitch a good game in the backyard with just a bat and ball. So maybe all we need is a few more bats and balls – Internet access, simple file transfer, CCR and some very simple game rules, so no one gets accidentally hurt…..  Let’s get all of us in the game before pretending to be Shoeless Joe Jackson.

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