Medicine is always flush with new innovations, from imaging technologies and new drugs, to robotics and minimally invasive surgeries that will doubtless continue to advance our ability to diagnose and treat maladies that afflict us. Our ability to understand the ever-increasing body of knowledge that is medical care, and to know when and how to apply that knowledge, has outstripped the capabilities of any physician or scientist. Absent advanced information technologies to integrate and sort through the data, clinical findings, possible diagnostics and treatments, clinicians may be overwhelmed -- data, data everywhere, but not a drop of usable information.
Thus, the most critical of technologies is not the new test or treatment, but rather health information systems that allow physicians to access information relevant to a patient or disease, mine that information to find the best and most efficient means of diagnosis and treatment, and, most importantly, share information across a myriad of computer software systems and health records.
But there’s the rub: Physicians are acutely aware of the benefits of adopting advanced health information systems and electronic records, yet the adoption of such systems -- outside of large practices and hospital systems -- has been sluggish. Solo and small medical practices, which still make up more than 50 percent of health care delivery in the United States, are slower to adopt due to greater financial strains, but the fact remains that even the larger practice settings will have to communicate with each other and with those smaller practices for all patients to benefit from information technologies, all of which requires interoperable systems.
It isn’t that doctors don’t desire the benefits to patients of electronic health records and data sharing among all medical care providers and research data banks, but rather, the piecemeal development of informatics and the high adoption costs have stymied widespread acceptance and implementation.
Put simply, American medicine faced the adoption of electronic standards for health care transactions under the Health Insurance Portability and Accountability Act of 1996. While electronic data exchange standards were set for limited transactions, no such standards were developed that allow for easy exchange of records and information between physicians’ offices, hospitals, labs, etc., let alone the ability to integrate and search that information in conjunction with programs to help identify disease probabilities and current modalities of treatment and guidelines specific to a given patient and their findings.
It’s not that such technologies don’t exist independently, but rather that so many proprietary systems have been developed that cannot exchange information and automatically “populate” the fields in these different electronic records with the corresponding information across different platforms. This renders the accumulated information nearly useless in assisting the physician in managing and caring for the patient. Add to this the high costs for both the hardware and software for fully integrated medical records, and the loss of office productivity during the initial adoption of an electronic record, and even well beyond the first few months of use, and we have a formula for failure.
In the current scenario, medical offices are expected to adopt these new systems without any real expectation that one system can communicate with another, front the costs, absorb the loss of time to see patients while an office learns how to use a new charting and tracking system, and then try to use the new information these systems place at our fingertips. Yes, there is a potential of payment for adoption under health reform, but for small medical practices, which remain the backbone of our delivery system, such incentives do not offset the real cost of adoption. To make matters worse, until one knows that the system on which tens of thousands of dollars will be spent will be able to eventually communicate with all other systems in play, there is a well-founded fear that one will need to switch later to another system at additional expense and loss of productivity, all while we already face a shortage of physician time to care for patients.
What is needed is rapid development and adoption of standards to which all of the proprietary systems must conform so that they may exchange and use the extensive data entered into these records, while securing that data from prying eyes or from those who would mine the data for profit that does not benefit the patient directly. In addition to the federal government, incentives to adopt need to come from private insurers, who in the end will reap the benefits of lower costs in avoiding duplicative and unnecessary testing, which can be tracked and avoided by well-tuned information systems.
With these elements in place, the adoption of electronic records by the majority of physicians will be advanced, with the potential to greatly enhance medical services. Combined with the ability to share information and use research data and other electronic resources seamlessly, the possibility of more accurate and more efficient diagnosis through better selection of tests and procedures based on best practices and guidelines can become reality.
This may or may not actually result in lower costs: As we become more aware of what tests need to be done and track patients’ compliance with such exams and treatments, the result may be greater use of resources rather than less use. But it should result in much better care and improved outcomes of treatment, which, after all, is the ultimate goal of medicine.
Dr. Mazer, San Diego County Medical Society (SDCMS) and California Medical Association (CMA) member since 1989, is a former SDCMS president and current SDCMS communications chair and CMA vice speaker.