Moving Health Care Into The Information Age
http://thekojonnamdishow.org/shows/2012-01-10/moving-health-care-information-age
It's a corner of American society that's been stubbornly resistant to the information technology revolution of the past few decades: health care. But the federal government is working to change that, using information technology to improve outcomes and relationships that patients have with their care givers. We chat with Farzad Mostashari, the national coordinator for health information technology.
Guests
Farzad Mostashari
National Coordinator for Health Information Technology, U.S. Department of Health and Human Services
Comments
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I have received health care in 5 different cities in the US. Although I'm relatively healthy there is medical information that has been left behind around the country like bread crumbs. To get a complete picture I would have to get copies of each of those bread crumbs. This is a harder task than you can imagine because health care providers are extremely reluctant to give their patients copies of paperwork because they fear it will be used in litigation. So, I really don't know the history of my cholesterol level, for example. I have a hazy idea and notes and numbers (levels) written on a host of notebooks and notepads - somewhere.
I or my insurance pay for blood tests & other tests, but I don't get a copy of the results. I have tried to include my name in the area to receive a copy, but the labs have never followed through.
On the front end, it drives me crazy when I go to a new physician or other health care provider, I have to give the same information that I have given to every other doctor of facility, even when I have had prior health records forwarded to the new physician. Everybody wants the information on their own form. I have to rely on my own memory to fill this out each time and my memory isn't getting any better over time.
Yet, one of the most important rules in medical care is getting a full history!
The only health care information I have not had to provide solely from memory is my child's vaccinations. That's because when he had the last set of vaccinations in year 1, the county health care wrote down on a credit card sized document, the vaccines they gave him, along with the vaccine information the prior pediatrician had provided on half sheets of paper after each vaccine.
When I take my dog to the vet I get at the end of the visit 2 sheets of paper with an itemization not just of cost, but of what was done, what medication was provided and the reason for the visit. I get the something similar on 2-3 sheets of paper from my auto mechanic. Hardly ever have I gotten something similar from a health care facility.
I have recently heard that health app research has reached such an extent of performance, that they manage to detect premature tremblings in Alzheimer`s disease, earlier than any other device could possibly diagnose it. This is entirely a breakthrough in the medical world. I also hear drug rehabilitation centers use revolutionary medical practices to ease the patients off their addictions, up to the recently released tracking bracelets and all sort of high tech devices.
Dr. Mostashari:
1) How about asking all those "CMS-auditors" to accept electronic communication? They still ask for paper records or faxes. Today I changed the rules in our office to charge them $1 per printed or faxed sheet + $25 per record requested in non-digital form. . These kinds of unfunded mandates are killing our practice
2) Labs ordered by one physician cannot be viewed by another.
3) Imaging studies ordered by one physician cannot be viewed by another.
ONCHIT needs to lobby on physician's behalf to repeal the "wrong interpretation" of HIPAA in these situations. The most cost effective approach is to change the laws to make the patient the sole custodian of the medical and all other information pertaining to their care.
All EMRS must be accessible by other doctors when patients permit them to view records. ( think of smart card/ biometric authentication to reduce paperwork) .
ONCHIT has wasted a lot of effort in this business of sending images to primary care docs( one of the meaningful use criteria) . Primary care docs have no idea how to interpret CT, MRI scans or look at slides. They depend on the reporting by the experts in those fields. Why this wasted effort?? All they need is ability to view the report. If needed, the patient can fetch the PACS file.
Large EMR companies are not releasing data for outcomes analysis without payment of huge fees. The price of these products is already in the 20 million range. Anonymized data should be available to physicians to do studies and improve care. Data should belong to patient and institutions that generate them. Data in silos is as useless as trash.
I strongly recommend ONCHIT moves its operational base to actual sites where these technologies are being used. Too much of taxpayer money is being wasted on clipboard nursing functions with no impact on patient outcomes. This will be borne out by more detailed evaluation of the utility of the current genre of EMRs.
EHR as currently mandated is not helpful to anyone. It lacks the detail and precision to be useful to doctors and can make patients worry about stuff they may not comprehend. My personal preference is to "push the record" to those who need it using a high level encryption.
NOTE: None of the current CCHIT certified EMRS can accept an incoming AES256 encrypted secure document and file it correctly without extensive user intervention. . .
Feel free to communicate with me.