Healthcare braces for federal IT czar

The nation’s first healthcare IT czar this week is expected to put forth a plan for modernizing the healthcare system – an effort IT professionals say they welcome despite the integration headaches and additional costs it could bring.

Dr. David Brailer, appointed by President Bush in May as National Health IT Coordinator, is set to unveil his plan at the National Health Information Infrastructure conference in Washington, D.C. The plan is expected to outline a method for creating an electronic medical record (EMR) for patients that any authorized individual in any medical organization from any location can view.

“It’s something that’s long overdue,” says Christopher Rose, a network specialist at Liberty Hospitals in Missouri. “One of the largest problems we face in delivering integrated care is that the systems we have don’t integrate well sometimes. This causes a lot of spending for interface building.”

“At a high level, we still have to see what the requirements are for this plan, the implications on [Health Insurance Portability and Accountability Act], the common languages and how we are going to interface [health information systems],” says Roland Garcia, CIO of Baptist Health in Jacksonville, Fla. “There are still a lot of details that need to be defined.”

The plan is expected to specify how organizations will be able to access patient health information, how that information is transmitted and accessed securely, and how software from different vendors is made interoperable so all information can be viewed from one source.

Madison Mock, CIO for the Medical Center of Central Georgia in Macon, says that setting interoperability standards between health information systems is essential.

“You need to set some standards that everyone adopts,” Mock says.

Many standards are already in place. Among the 15 standards outlined by the U.S. Department of Health and Human Services are Health Level 7 (HL7), a method for exchanging clinical data between diverse healthcare information systems, and SNOMED CT, a standardized medical vocabulary.

However, such standards don’t completely solve the problem of interoperable health information systems.

“Even the HL7 standard is a little loose – it doesn’t cover some of the issues of sending image data,” says Mark Moroses, senior director of technical services and security officer at Maimonides Medical Center in New York.

“In imaging there’s a push toward DICOM2 systems, but it’s not accepted 100% across radiology systems. There’s a lot of questions regarding the transmission format and the file format and how you can display the information,” he says.

Another issue Brailer’s plan is expected to address is physician adoption of EMR.

Moving to EMR for many medical institutions is a generational issue – older doctors are often more comfortable hand writing medical instructions, industry watchers say.

Some physicians and healthcare organizations also are skeptical about the immediate financial benefits of moving to EMR.

“Most institutions have started to [move to EMR] because the savings in creating an electronic medical record drives down [medical] errors, which ultimately drives down insurance costs,” Moroses says. “We were able to lower our malpractice insurance and [that] of our doctors because we wiped out certain medication errors.”

Not that adopting new health information systems is easy or inexpensive, he says.

“They are million-dollar acquisitions, so companies aren’t going to do it just because the government says they should in 10 years,” Moroses says. “They are going to wait for the life cycle of their systems to cycle out and for their vendors to make revisions to include the functionality outlined in Brailer’s plan. That’s not going to happen overnight.”