HIMSS09: The gold rush is on for health care IT

Jay Rollins notes that the $19 billion open to health care IT has had an effect on the exhibitions and offerings at this year's Healthcare Information and Management Systems Society (HIMSS) conference. Read some of the startling statistics presented at the event.

Jay Rollins notes that the $19 billion open to health care IT has had an effect on the exhibitions and offerings at this year's Healthcare Information and Management Systems Society (HIMSS) conference. Read some of the startling statistics presented at the event.


More than 900 exhibitors have filled the halls of the McCormick Convention Center in Chicago during this year's Healthcare Information and Management Systems Society (HIMSS) conference. Many of the exhibitors tweaked their offerings to fit the requirements for the $19 billion open to health care IT. For instance, an entire track of educational sessions are geared toward how CIOs of health care companies can take advantage of this opportunity and get their share of the stimulus pie.

George C. Halvorson, Chairman and CEO of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, was the keynote speaker on Monday morning. He is pushing for a more systematic approach to coordinated health care.

To give some idea of the state of health care IT, Halvorson noted the goal of the Institute of Medicine (IOM) is that, by the year 2020, 90% of care in America will be based upon scientific evidence. Many believe that goal is too easy and others view it as impossible, according to Halvorson. It would be like Boeing saying that its 10 year goal is that its planes will not crash 90% of the time. Any other industry comparison would have similar stark differences between its goals and those stated by the IOM. Most companies strive for six sigma (three errors per million), and health care is struggling to get to two sigma.

Other startling statistics were presented based upon internal research, and research conducted through a Rand survey, which include the following:

  • Barely 50% of adult diagnoses and treatments are correct.
  • 46% of child diagnoses and treatments are correct.
  • 80% of health care costs can be attributed to 10% of the patients.
  • Diabetes represents 32% of Medicare costs and is treated correctly only 8% of the time.

Clearly, there is a lot of work that needs to be done and not a lot of time to do it.

From an IT perspective, it appears that health care IT is pretty straightforward. We have been building out data aggregation systems for decades now. If we have the data, we can build it. Other issues become roadblocks to getting these things done and not the least of which is patient privacy.

In another session, Dr. Deborah Peel outlined the issues associated with patient privacy. In the psychiatry field, patients are very concerned about privacy. "600,000 people refuse to get early diagnosis and treatment because of privacy fears," said Peel. She also pointed to the military as an example. Medical records in the military are not private and, as a result, soldiers returning from Iraq or Afghanistan are committing suicide at the highest rate in 30 years because they do not seek help dealing with Post Traumatic Stress Disorder.

Every vendor at the conference has a solution to these problems; one interesting idea (although it was oversimplified in the presentation) is the idea of a health record bank. The relative newness of these technologies will flesh out relatively quickly. This is due to the huge incentives included in the stimulus bill for health care providers to become early adopters.

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D. Kellus Pruitt
D. Kellus Pruitt

On Monday, in Bob Brewin?s article on, Dave Roberts, the HIMSS vice president for government relations, said ?The e-records initiative is an entitlement program like Social Security.? Is that an accurate statement?


Entitlements usually take Acts of Congress. At the most emr's would be a requirements for certification, and those certification requirements are even more likely to come as specifications for an overall system rather for generic emr's themselves. For example a small hospital servicing stable population may not require an emr system of their own to obtain copies and send copies of old record very quickly if not quite in real time. Interoperability, in my opinion, means the ability to send and receive any known medical information from all previous encounter in a machine readable, coherent pattern facilitate recognition of details, patterns and trends in the patients health. This would most likely be facilitated by a universally indexed, optimally secured and electronic record borrowed from a repository universally indexed for provider in any location under any legal circumstances under ACID procedures(no doubt). Such a access to records give the care giver infinitely more options in prompt, precise treatment of patient problems. There is actually a wealth of research from the late 1970's that is classified under "continuity of care." The research conclusively to my satisfaction demonstrated that patients both received better care and had improved outcomes if the care was managed by one physician or a a small group of doctors using the same chart. Doctors with at least chart continuity, know what the patient had as a baseline for health, know what a patient was likely to get in terms of additional problems, know what interventions that have been previously effective and ineffective treatment, and divergence from any expected previous patterns that would be cause for alarm. Changes of a patient's state of health could be identified with greater alacrity, precision and agility. With my own patients, travel outside of convenient access to my office frequently resulted in some catastrophic complication because a new doctor simply did not knowledge base regarding a particular patient to provide the highest quality of care. Homework helps. Approaching a potentially complicated problem would be like a great lawyer approaching a critical trial without reading the case brief. With the mobility of our society the problem is multiplied. So, what are called "old charts" can light the path to decisive, effective, lower cost care. It is indispensable. So how should the chart be formated. The medical community in generally has come up with the format of the Problem Oriented Medical Record initially developed and championed by Dr. Larry Weed. The whole idea of a PrOM format is and aid to cognition in aiding clinician solve extremely complex problems with the greatest facility. Thus, how the information is presented is key. Anyone who does no recognize this fact has his/her head screwed on backwards. Toward the above goals and optimal application of the massive information organizing capability of even the smallest computers today. Any entry that can be elevated to code (CPT, ICHPC and the like), should. An open schema of the electronic record is multiples more effective and should is a necessary criteria of inter-operability. A level of granularity of information in the chart where medical records were completely informationalized and available in real time. By "informationalized" I mean that signs, symptoms, lab results, diagnosis and other data all be in a standardized and represented by commonly accepted code such as CPT and ICHPC and others to cover every informational aspect that the chart can carry. Free text is a waste of space and does not fully elevate the data to its highest level of utility as information . Let's say a patient is admitted to an out of town hospital with a medical history that normally fill 150 pages with text. To further complicate the normal lack of continuity of care that the patient is experiencing, the patient has a severe intolerance to a particular medication that happens to be listed in one of its proprietary names. O.K. we can stop here and compare a bit about the value of internationalization. The patient with a chronic disorder and these particular bouts of decompensation are frequently treated by the medication we mentioned above but only known locally by the generic name of another proprietary name. In the above example all kinds of in efficiencies arise with peril to the patient's well-being, and the hospital and the health care team. First transfer of this much paper takes time and wastes paper. Even if the information is in text the reader might not recognize, say, the name of the medication in non-standardized form and that is after he has read through the 150 pages, at worse, and at best, with document mining tools and search may erroneously conclude there is no apparent histories of intolerances because the two different words cannot be connected as equal without going over the whole document with a comprehensive thesaurus to pick up the patient's intolerance to the drug. People don't do well at these tasks reading and interpreting information. Computers do exceptionally well at the above tasks while humans are very susceptible to boredom and lack of up-to-the-moment-knowledge necessary to expedite quality care and obviate mistakes. The fact is that the government insist on a certain set of functionalities to assure results. The pressure from emr's to grow and their designers to prosper, should be coming from the doctors, patients and administrators. There are a few more critical aspects in managing medical information that I'm not going to discuss here. It is clear that the government has some very precise criteria such as "interoperability,""meaningful use" and "privacy." Set in a country where health care costs are 30% more than any other system in the world and rank 38th in objective measures of health care, one step above Cuba, it would be extremely unlikely to have any explosion in e medical records with substantial savings of both money and lives.

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