Health IT Gains Momentum, Slowly

Gradual adoption is best, considering all the potential facets and tools that health technologies can offer, said EHR Workgroup Chmn. Lillee Gelinas: It will ensure that “the perfect [doesn’t] trump the good,” she said.

Experts in charge of creating EHR technical standards presented AHIC preliminary guiding principles, which will be updated as technology evolves. “Imagine if you bought the first version of [Microsoft] Word, chances are there would be a service pack. Well, we have finished version one [for health IT standards], and we will be delivering a service pack” for this and all the versions to come, said Healthcare Information Technology Standards Panel Chmn. John Halamka. The group took “into account the best of standards today and created a single implementation guide continue to refine it,” he said: “Standards should allow permutations of architecture,” and adapt to rapid changes. Flexibility is also important, so each health community can meet minimum standards while tailoring them based on privacy risks and other factors, he said.

On the road to complete presidentially-mandated EHR adoption in 2015, public and private organizations across the country are fleshing out the govt.’s vision. “We've seen innovation and creativity in very many groups,” said National Health Information Technology Coordinator Robert Kolodner: “What we're doing should represent the floor and not the ceiling.”

Doctors in private practice and in govt.-run research facilities and health systems are integrating human genome information into EHRs, some told AHIC. “It’s very clear that understanding a patient’s genome is critical” to treatment: Health IT offers an “interpretation engine,” said Harvard Partners Health Care System CIO John Glaser.

But when personal, genome-level information becomes searchable digitally, maintaining “public trust” is crucial, said Gregory Downing, dir.-Office of Technology, NIH. If privacy is assured -- by “anonymizing” and “deidentifying” data -- EHRs can present physicians with “data in a fashion that answers [key diagnostic] questions,” he said: Some EHRs in use already integrate and “intelligently link” such data.

Doctors will eventually be able to perform “in computer” clinical research and trials, Downing said: But EHR data now are still “messy” and “quite poor.” Although efforts are still in “early” stages, “if we're 5 degrees off or 50 degrees off, we're reducing the shareability.” Now is the time to make mistakes, because soon health care providers will have to manage “phenomenal amounts of data,” even petabytes, he said.

The VA -- which already boasts a fully operational health IT system for its 5.3 million patients (WID Oct 12 p5) -- is working with veterans themselves to start adding genomic data to its databases, said VA Chief R&D Officer Joel Kupersmith. Focus groups help measure patients’ attitudes toward the technology, he said: “There’s a practical need” for this “precedent setting” project, particularly for the VA’s mostly older, poor patient base. The plan also includes physician decision support and education, he said.

Health IT can also streamline medical research, said Anthony Hayward of NIH. Communication between doctors and patients involved in clinical trials already communicate “mostly” via e-mail, he said.

An electronically connected health system will one day help the govt. manage outbreaks and apply countermeasures, said Art Davidson, AHIC’s biosurveillance steering group co- chmn. The group is working through national planning scenarios involving 33 public health information networks. But to serve the public and protect sensitive data, standards must “ensure that only required data elements are shared” and enforce a “filtering mechanism,” he said. The final version of a biosurveillance infrastructure could be led by Centers for Disease Control, he said. - Alexis Fabbri