Regenstrief: Health IT falling short of its potential

Federal HIT office is in the best position to lead change, says Burke Mamlin, MD

If healthcare information technology is to fulfill its promise of improving health outcomes, the country needs a “rational and well-funded” agenda for HIT development, use and assessment.

That’s the finding of a wide-ranging evaluation of current health IT by the Regenstrief Institute and its conclusion regarding the barriers that must be overcome to move the industry forward.

“We have been making progress, but there’s definitely a gap between where we are today and where we would like to be across a lot of aspects of health information technology,” says Burke Mamlin, MD, a Regenstrief Institute investigator and Indiana University School of Medicine associate professor of clinical medicine.

Researchers examined seven technology areas: EHRs, health information exchange, patient portals, telemedicine, social media, mobile/wearable devices, and privacy and security.

Among their findings published in the American Journal of Medical Sciences:

  • Steps to improve EHRs should include a universal programming interface, universal patient identifiers, as well as better documentation and data analysis.
  • HIEs require federal subsidies for sustainability and support from EHR vendors, targeting seamless sharing of EHR data.
  • Patient portals must bring patients into the EHR with better design and training, greater provider engagement and leveraging HIEs.
  • Telemedicine needs sustainable payment models, clear rules of engagement, quality measures and monitoring.
  • Social media requires consensus on rules of engagement for providers, better data mining tools and approaches to counter disinformation.
  • Mobile and wearable devices would benefit from a universal programming interface, improved infrastructure, more rigorous research and integration with EHRs and HIEs.
  • Laws for privacy and security need updating to match current technologies, and data stewards should share information on breaches and standardize best practices.

According to Mamlin, the National Coordinator for Health IT is in a position to lead an overarching effort at a national agenda for HIT, with funding for research and development tied to EHR implementation coming from both federal sources (for general infrastructure such as enhanced wireless communications, the universal platform or API and objective research showing what works and what benefits can be expected) and the private sector for EHRs, HIEs, PHRs and other large-scale software systems along with apps.

“When it comes to electronic health records, we took billing systems and turned them into order entry tools and have been iteratively making improvements on them, but there are some aspects of clinician workflow that are not served by the processes we have in place such as burdensome documentation,” says Mamlin. “The promise of EHRs is that someday they will get out of the way and we can get back to the point where doctors are interacting with patients and focusing on their care.”

In addition, Mamlin makes the case that the many different EHR systems implemented across the country have limited ability to share information. Despite the widespread adoption of EHRs, he argues that correctly identifying patients and accurately matching their records as they are shared across healthcare organizations continues to be a challenging problem for the industry.

However, Mamlin points out that Congress continues to block a sorely-needed nationwide unique patient identifier, which would enable accurate, timely, and efficient matching of patients with their health data.

“They’ve literally gone out of their way to prevent what would be very helpful,” he concludes. “When you’re trying to match records across states or between different hospital systems, universal patient identifiers would definitely be valuable tools. My hope is that the private sector doesn’t quietly wait around in frustration and takes no action until the legislative environment changes.”

Current law prevents the Department of Health and Human Services from spending public funds on a national patient identifier, putting the onus on the private sector. Stepping into the breach, the College of Healthcare Information Management Executives in January launched a $1 million National Patient ID Challenge aimed at developing a solution that ensures 100 percent accuracy of every patient’s health info to reduce preventable medical errors.

CHIME has teamed with crowdsourcing platform HeroX to run the year-long competition that is open to innovators from around the world to develop a solution that is private, accurate and safe. The grand prize winner will be announced in February 2017.

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