At a U.S. House of Representatives committee hearing yesterday on the inability of health care providers to use IT systems to exchange patient records, Republican Bart Gordon told a real-life medical story to illustrate the problem.
Gordon, who chairs the House Committee on Science and Technology, said a committee staffer had open-heart surgery and was also diagnosed with diabetes. The worker compiled a list of every condition he had and all the medication he was taking and put it on a card that he kept in his wallet. Later, he suffered a stroke, and medical personnel used the information on the card to help guide their treatment.
"If those records hadn't been available, who knows what would have happened?" said Gordon. Technology in the U.S. is advanced enough that people expect doctors to be able to access important medical information from any system, he added.
But information sharing that could eliminate the need for wallet cards such as the one carried by the committee staffer is still many years away, Gordon and his fellow committee members were told at yesterday's hearing.
According to the testimony they heard, there are no widely adopted technical standards, many medical records remain paper-based and inaccessible, and the health care industry as a whole is spending only about two per cent of its overall revenue on IT.
"It's a daunting challenge we have," said Noel Williams, CIO at HCA Inc. and president of its HCA Information Technology & Services Inc. subsidiary. Nashville-based HCA, which formerly was known as Hospital Corporation of America, operates about 170 hospitals and other medical facilities in 20 states as well as in England and Switzerland.
"Part of the problem is we have too many standards," Williams said. She added that there are more than 2,000 standards in the health care industry, and that some 400 organizations are involved in standards development. What's needed is an agreed-upon set of standards, she argued.
Physicians, particularly those operating in private practices, need to know whether the IT investments they're making will be worthwhile, said David Silverstone, a clinical professor of ophthalmology and visual sciences at Yale University School of Medicine in New Haven, Conn., and assistant chief of ophthalmology at Yale New Haven Hospital.
"Integration is that key - we need to know that the systems we purchase will be able to work with other systems," Silverstone said. He added that when patients are referred to him by another doctor, he has to repeat tests and record medical histories that are available in systems but remain inaccessible to him. If he could get patient data in an electronic format, it also could be analyzed more easily, Silverstone said.
President Bush has set 2014 as the goal for moving the majority of health care providers to electronic medical records. That could eliminate or minimize problems such as those cited by Silverstone and the possibility of adverse drug reactions because of doctors having insufficient information about the medication histories of patients.
But while there is agreement on the need to fix health care IT interoperability, disagreement about the best approach to take was evident at the hearing.
Gordon used the hearing to promote a bill called HR 2046 that would direct the National Institute of Standards and Technology (NIST) to develop a neutral standard for information sharing within the health care industry.
But that isn't a new goal, and some of the witnesses who testified at the hearing as well as other committee members voiced concerns that NIST's involvement would trump existing efforts to establish interoperability and potentially set them back.
For instance, Ralph Hall, the ranking Republican on the science and technology committee, questioned whether Gordon's measure would work at cross-purposes to a standardization effort under way within the U.S. Department of Health and Human Services. "Will this bill derail that process or set up a parallel process?" he asked Gordon.
In response, Gordon said NIST wouldn't be setting policies, just standards. He added that the agency also would have the ability to test the standards to give them "a Good Housekeeping seal of approval."
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