I’m often asked by people in non-healthcare IT fields about where health and medical IT is headed. With all the publicity health IT is getting these days, lots of my friends want to get into the field but aren’t sure where to start. In case some of you missed the article from earlier this year, Healthcare Informatics talked about that particular topic in Nine Tech Trends, Healthcare IT advances are pulling together to manage an expanding universe. Some ideas from the article:
Bar Coding and RFID:
Even for medication management, active RFID has clear advantages over bar codes, which must be scanned on the surface of the object itself. In patient management, too, locating, tracking and reading are more advanced and immeasurably easier with RFID tags that can be read at a distance, Subramany says. In fast-paced hospitals, this may be a key consideration and one that speaks to optimal resource utilization, he adds.
In the past, when it came to identifying high-risk patients, payers and providers each had select pieces of data, but neither had the complete health puzzle. Predictive modeling tools, commonly used by payers for risk stratification, tapped into claims and pharmacy data and utilization rates but not the rest of patients’ medical records or lifestyle information, Drazen says. Primary care physicians, who might see patients only a few times per year, usually spent office visits treating illness instead of promoting wellness. Some providers tagged patient charts for certain chronic diseases, but such initiatives tended to fall apart if patients failed to return for needed tests.
These days, more providers are running disease management programs using computerized patient registries, which contain patient-service checklists and sometimes provide electronic alerts on patients who are overdue for tests or services. But many physicians cannot afford the IT investments, notes DMAA’s Selecky. “I’m a huge proponent that disease management should be done at the provider level,” she says. But “most providers operate in small environments where they don’t have sophisticated technology to do the database analysis, predictive modeling and risk stratification.”
Electronic Health Record (EHR):
The reality, according to Garets, is that not one EHR has been successfully implemented. A successful system, he insists, has to include controlled medical vocabulary, real clinical decision support, workflow enhancement, electronic medication administration, and integration of nursing documentation, the pharmacy and the supply chain. “There are a lot of people that are making a lot of progress,” he says, “but nobody has all that stuff, plus patient access and input.”
It’s not just technologies and programs focused on emergency preparedness that are increasing. So is awareness. “Our philosophy since 9-11,” says Melissa Sanders, chief of HRSA’s hospital bioterrorism branch, “has been that we as healthcare providers have got to re-tool our thinking. We’ve got to become more comfortable with emergency response, with incident command systems, and that whole structure of how information flows in an emergency.” *
…the rise of EMRs and, especially, computerized physician order entry is creating an environment in which physicians not only want but demand access to images and data from a variety of specialties. In that environment, PACS cannot remain something that radiologists “own.” It must become another of an emerging array of clinical tools.
Referring physicians won’t necessarily want to access the diagnostic-level PACS images that radiologists will still use, but in the coming years, they will have electronic access to a far wider range of data and images from multiple specialties, Dreyer says. And the technology is already there to facilitate this access. Partners Healthcare, the gigantic integrated parent organization for Mass General, has had a hierarchical management system central archive in place since 1999, so “anybody in any department can see the images from anywhere else,” Dreyer says. Partners also developed its own EMR and supports its archiving with jukebox technology.
IT and Biomedical Devices:
…demand for patient monitoring systems is expected to grow 6.7 percent annually by 2008. Roughly half the sales–$3.6 billion–will go toward hospital systems and the rest to home monitoring equipment and the like. Freedonia has no statistical data indicating how much of that patient monitoring equipment will process and produce digital information, but anecdotal evidence, and common sense, points to ever-accelerating digitization.
Web portals that allow patients and physicians to communicate online have a firm foot in the door. “There’s certainly evidence that organizations are investing more in portals,” says David Ahern, national program director for Boston-based Health e-Technologies Initiative, the foundation arm of the Robert Wood Johnson Foundation, Princeton, N.J. “All the major players in healthcare have had an interest in portal development.”
…Finding a way to save money may be the primary driver behind portals, but improved patient care is expected to come along on the ride. Some good research has been done in this area, Ahern says, but nothing very scientific. “There certainly have been studies looking at the cost benefits of certain functions; for example, in the area of secure messaging.” However, there has been no study “looking at a range of functions, although some are emerging,” Ahern says.
Lack of experience in collaboration and data sharing–not to mention building and managing a shared clinical information systems infrastructure–is a big problem. Few regions have a history of organizations sitting down together and solving complex problems. Learning how to govern themselves and developing trust will take time.
…As leaders seek a sustainable financial model to achieve quality-improvement goals, IT also needs to pay off economically. A real market is developing, notes Steindel. “The large vendors smell money in HIT, and when people smell money, they tend to fill [the market] pretty quickly,” he says. “President Bush says he wants an EHR in 10 years. I think it will be five.”
Already popular, rural telemedicine uses continue to grow. For the past year, through a system designed by Anchorage-based GCI ConnectMD, the Alaska Psychiatric Institute has been delivering remote care via videoconferencing. CEO Ron Adler says a high-bandwidth link has been established with Fort Yukon, a village more than 100 miles away, to allow his staff to visit with patients and observe their behavior.
“The benefits of bandwidth and the ability to zoom in on the features of a child, for example, are amazing,” says Adler, who oversees the largest psychiatric clinics in Alaska. “A child can be 15 or 20 feet out from where the camera and video equipment is located, and the picture’s so good you can see a teardrop forming in their eye.” And adult patients “completely forget you’re speaking to them through a television monitor” by the second or third teleconference, Adler says. The institute offers a full range of behavioral health consultations through videoconferencing, from depression and chemical dependency counseling to dealing with family and children’s issues, he says.