Monday, February 06, 2006


Healthcare in the Network Era

I recently attended the Healthcare panel at Saturday's Symposium, and had the opporunity to hear John Halamka speak about IT. I felt some of what he had to say was relevant to our coursework, so I am going to summarize (caveat: perhaps imperfectly) what he had to say in the context of the network era.

As we have learned in class, the increasing ability to communicate electronically via increase in bandwidth, connections, and computers has brought about the Network Era. With the start of digitization of medical records, this has brought about an incredible opportunity for clinical data exchange between healthcare providers, payers (insurance, etc), and patients.

However, Mr. Halamka stated some facts: on average, only 15% of clinicians are currently using medical reccords (25% in MA, but 5% in North Dakota, for example). He stated several reasons for this:
  1. Lack of standards for interoperability. Why is this? How is it that we can go to some bank across the world and access our financial information to get money through an ATM, for example yet can't easily get our medical record across the block?
  2. Politics, security and privacy issues. (a) Some patients just don't want their data in an easily accessible electronic format. (b) If a person is HIV positive or has a history of substance abuse, state law prevents the access of data - you need consent from the insurance company paying for the treatment even if the patient has a relationship with the doctor.
  3. Doctors just don't know what to purchase. With 133 different database vendors from epic in size to doctor bob's personal database, each with its own bells and whistles and data types (think proprietary digital music formats), it's difficult to get certified compliance.
  4. There is no architecture for the exchange of data. I didn't quite get what he meant by this as I was sitting on the floor because the room was packed and it was getting uncomfortable, but I believe he meant standard ways to perfectly ensure secure transmission, format for auditing, etc. In addition, if 5 hospitals have 5 different ways of coding medical records and there are 5 records on a particular patient, which do you use?
  5. There is a lack of alignment of incentives for clinicians. So if a doctor spends 10% of his income to purchase a system, but then decreases his productivity by 20% or so for a year to learn the use but at the end of the day the insurance companies reap the benefit of better information, what is the incentive?

With the cutbacks on government funding for healthcare, it's possible that this reduction in spending will be at the expense of technological innovation as healthcare providers provide only basic services because it's too expensive for people to pay. This issue also brings to mind Dannyboy Towers' post security becoming a layer; I didn't see any other posts by our class but it is definitely something to think about.

There are alot of issues to consider but do you think its possible? Should this successfuly be implemented, what do you guys think the impact factor would be on the healthcare industry?

dannyboy here, the ATM issue is one of interoperability. The ATM industry is 20 years old and has reached a level of maturity. The main drives with ATM are the interchanges. They aren't many of them and they know that they need to work together (in order to take advantage of the power of the connectivity law).
my other post is lost.
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