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Healthcare Automation—What the Public Should Know

The US healthcare industry is in transition to electronic health records (EHR), electronic integration and automation. If there were greater public appreciation for the benefits, then the transition might be accomplished sooner.

 

I recently attended the SOA in Healthcare conference organized by the Object Management Group, an IT standards organization, and sponsored by Hewlett-Packard.  While the conference is based on increased automation and electronic exchange of information between providers and payers, most of the presentations focused on the business challenges and the impact of this transition.

 

In 2007, US national healthcare cost was $2.2 trillion, $7,421 per person, and represented 17% of the Gross National Product.  Electronic automation and integration are expected to reduce this cost and improve the quality of care.  However, the transformation is not supported by business incentives.  Most providers have systems for internal automation, and they do not see a business benefit from making their information available to other providers.

 

The keystone of integration and automation is the Electronic Health Record (EHR).  A standard EHR will enable providers to electronically share and access the medical records of a patient.  This does not sound like a big deal, but there are many different kinds of records and many different structures for every type of record so that a record from one provider typically cannot be processed by the computer system of another provider.  This diversity will take years to resolve unless there is considerable pressure to resolve it sooner.

 

Benefits

I believe that if the general public were more aware of the benefits of integration and the EHR then there would be more political pressure, and the transition would move more quickly.  Here are benefits that I see:

 

Improved treatment.  More complete, timely and accurate information will enable more timely and accurate diagnosis and treatment.  Decision support tools can identify relevant information and provide guidance to clinical decision-makers for better decisions.

 

Access to experts.  National experts can gain access to patient records for remote interpretations  and consultations.

                                                                     

Personal history.  Patient history, including prior illnesses, injuries, medications and medical tests will be available for consideration along with personal and family history factors that may signal medical risks or causes of current symptoms.

 

Personalized medicine. Declining costs of personal genome (DNA sequence) will make genetic information available for improved diagnosis and treatment where genetics are a factor.  See the MIT Technology Review group of articles on “Personalized Medicine.”  Genome data should be available to be considered wherever a patient receives treatment.

 

Reduction of errors. Records and supporting applications can more reliably identify allergies, possible medication interactions and risks of side effects.

 

Lower costs.  Test results will be shared by providers and duplication avoided.  Applications can provide guidance for more accurate and timely diagnosis and treatment to reduce the need for tests and reduce the severity and longevity of an illness.

 

Analysis of medication effects.  Reactions of large populations to medications can be analyzed for effectiveness and side effects.  Serious side effects of some medications can be more quickly recognized and risks may be associated with certain population groups to retain benefits for others.

 

Epidemiology.  Populations can be studied for the occurrence of particular diseases and disorders to identify high risk circumstances and potential causes.

 

Early detection of epidemics.  Emergence of diseases patterns can be identified and localized more quickly for development of treatments or quarantine if necessary, reducing the risk to the global population.  The US Department of Defense has medical records of personnel deployed around the world.

 

Treatment of disaster victims.  In major disasters such as the Katrina hurricane, displaced persons can receive prompt and appropriate treatment if records comply with standards and are appropriately backed up.

 

Case management automationAutomated case management will provide an environment to bring together timely response to patient conditions, clinical guidance specific to the patient, improved coordination and timeliness of care, and improved record-keeping.

 

Risks

Electronic health records will make comprehensive, lifetime, patient medical information available anywhere.  This creates some risks. 

 

Privacy risks.  Unauthorized persons might gain access to medical records and violate patient confidentiality.  This is both a technical problem and a problem with education of patients to limit authorizations for access to their records.  Epidemiological research must be restricted to not reveal information that can be identified with individuals.

 

Medical discrimination.  Medical information could be used to discriminate against patients for insurance or employment.  Insurance companies and employers may have legitimate access to medical records, but regulations should restrict their use.

 

Erroneous test results and diagnoses.  Erroneous test results or diagnoses will follow a patient everywhere and may result in inappropriate treatment.  Appropriate procedures must be defined to recognize and correct such errors.

 

These risks may be asserted by those who do not want to invest in the necessary transformations.  However, the risks can be addressed with security technology and proper legal and administrative controls and accountability. 

 

Current efforts seem to me to be rather fragmented.  There is a need for timely agreement on standards and coordination of investments both to minimize the time and cost of transition, but also to ensure that the risks are addressed and protections can be easily validated and audited.

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