Means to untangle health data still a long time in coming

Key Points

THE WORLD OF healthcare is chock-full of information-billions of pieces of data that tell the day-to-day story of patient-provider encounters. But because of the disparate nature of health IT systems, the data is so fragmented it's actually hampering clinical decisions.

"It would be wonderful if we had a system where clinicians from one facility could access patient information from another facility," says Mary P. Griskewicz, senior director of ambulatory information systems for HIMSS. "It would provide better overall care. But that level of integration is not there yet."

Experts in all areas of the industry emphasize that achieving a level of integration envisioned for the future of healthcare, in terms of costs savings and improved patient care and outcomes, will transform the way healthcare is delivered. While everyone has a vision, the stark reality shows that interconnectedness will be a long time in coming.

That makes integration one of the most gut-wrenching issues among IT executives. It's territory fraught with challenges based on the fact that the information is managed by many different entities and resides in: electronic health records (EHRs) and e-prescribing tools; personal health records (PHRs); lab databases; patient registries; claims data; and in mountains of paper documents.

In a survey of MHE readers released in October 2010, 37% of payers and 40% of providers indicated they were participating in a regional health information exchange.

TO EACH HIS OWN

So how can technology systems communicate with each other? The industry and U.S. government are undertaking a number of initiatives to move the process along.

Adoption is the first hurdle. Providers must continue to adopt EHRs and e-prescribing tools, and more members must be willing to utilize PHRs. If members see the value in electronically accessing their medical history and latest medical results, it may help them in overcoming doubts about security.

Experts agree that the inability to move clinical data from provider to provider must be solved. To that end, the Office of the National Coordinator for Health Information Technology (ONC) will be including more measures of interoperability in Stage 2 of the Meaningful Use requirements and more certification criteria directed toward interoperability to support Stage 2 Meaningful Use. ONC's current certification process is temporary, because of phase out when its permanent certification program is operational, which is expected to happen this month.

The public and private sector continue to work on standards of implementation. The Department of Health and Human Service's HIT Standards Committee convenes stakeholders from government, industry, provider, payer, and academic organizations monthly to define the issues and advise HHS on the content, vocabulary, and transmission/security standards needed to interconnect healthcare.

Substantial work has been accomplished during the past five years, leading to regulations that specify data content; the way that specific problems, medications, and laboratories are described, and the security controls that protect privacy, says John D. Halamka, MD, co-chair of the HIT Standards Committee and chief information officer of Beth Israel Deaconess Hospital. Additional work will be done during the next year on transport standards-how to get data from point A to point B, he adds.

Long term, the challenge facing the industry is to integrate data by episode of care from multiple sources in a seamless way, says Susan Penfield, senior vice president of Booz Allen Hamilton and a specialist in the management and strategic use of information technology. She believes the healthcare industry in general can learn lessons from closed systems that are successfully integrating information that is standardized and accessible to every provider and patient in that system.

Kaiser Permanente (KP) has created a system that integrates all elements of care, including lab and imaging capabilities, hospitals and physicians, and clinical support. As an integrated healthcare system, KP can give providers and members access to actionable information through EHRs and PHRs.