Check out our Healthcare Information Management section for more information or to find companies that provide these products and Services.

These are heady times for healthcare information management in the United States. After years when proponents of new, enabling informatics technologies battled recalcitrant medics, the Obama administration changed the tug-of-war. Congress’ 2009 economic stimulus package included $27 billion for digitizing healthcare information. That’s a powerful carrot—up to $63,750 for physicians and millions for hospitals. The proverbial stick (in the form of mandatory regulations) follows in 2013 and 2014.

It’s all contained in HITECH, the Health Information Technology for Economic and Clinical Health Act. New York Times pundit Robert Pear wrote (July 13, 2010), “Even though American health care is known for the use of advanced technology in treating patients, doctors and hospitals have been slow to replace paper records with electronic records.” Pear quotes U.S. Health and Human Services Secretary Kathleen Sebelius, “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records.”

The idea is simple, and the potential benefit is great. Replacing paper records with electronic media should improve the quality of care while containing the rising cost of delivering health services. At first blush, it seems like a win-win situation. However, the sanguine predictions must be tempered with caution and risk management.

On the plus side:

• Patient records, which may become more comprehensive, certainly will be more legible, systematic, and uniform.
• Information will be widely available and quickly retrievable. Hospital test results will be easily produced in physicians’ offices, for example.
• Medical information will be more interoperable; new standards will make digital information from one system readable in many systems.
• There should be fewer medical errors. Prescriptions will be legible, and software should prohibit negative drug interactions and errors in dosage. Software also will prohibit harmful prescriptions for patients with known allergies.
• Expected cost savings from improved processes and accuracy range from modest to dramatic.

So sing the minstrels of blue skies, bluebirds, and butterflies.

Unfortunately, there is also a cloudy, darker side:

• For providers, the rollout of digital healthcare information will be expensive, befuddling, time-consuming, disruptive, and, possibly, maddeningly buggy.
• Initially, real standards will be unavailable. Meaningful standards will only evolve with common usage.
• Information systems will struggle to administer increased loads of processing, communications, storage, and more.
• There will be egregious breaches of privacy and security.
• There is no current plan for refreshing healthcare records as technologies become obsolete.

At this writing, there is no question of direction: healthcare records will go digital. Even before HITECH, that was already happening at leading facilities, like Geisinger Health Systems (eastern Pa.) and Olmsted Medical Center (southeast Minn.). The federal mandate merely accelerates this switch and makes it more consistent across the U.S. The trendsetters have already enjoyed the benefits and bumped up against the obstacles.

Most patients appreciate having their healthcare provider electronically send prescriptions to their favorite pharmacy. However, many are disconcerted when they relate their physical issues to a medic who is typing on a keyboard instead of making eye contact. Similarly, patients like the convenience of wide availability of healthcare records; they value the possibility, for example, that after a major procedure at a central, specialized facility, their records are available at their local satellite clinic for subsequent re-checks and evaluations. These same patients will be less pleased if their privacy is compromised through data losses.

Issues for IT

The mandate to spend $27 billion has spawned a virtual feeding frenzy among current and potential providers of electronic health record (EHR) software. From global systems providers to mom-and-pop application developers, solutions vendors launch a barrage of marketing at the information technology officials at healthcare facilities. No doubt, these are boom times in healthcare informatics.

IT leaders, however, struggle against the same challenges as last year: limited staff, limited resources, and limited expertise. Most have yet to see the budget bump for capital purchases. Even when the federal money filters down to IT, evaluations of software compliance standards will be difficult.

“There is great promise,” opines David Partsch, program director at Geisinger, “in the establishment of standards such as the IHE framework for the sharing of structured and unstructured data types between healthcare organizations.” IHE is an initiative by healthcare professionals and industry leaders to improve the way computer systems in healthcare share information through existing standards.

Despite the promise, Partsch identifies the current and ongoing challenge: “Staying ahead of the curve with respect to increased storage needs, given the continued escalation in the amounts and types of information created at a healthcare organization.”

Looming Challenge

Clearly, in EHR, this is a heady time of progress and unprecedented funding: solutions providers strive to grab market share; hospitals, clinics, and practitioners feel pressured to progress before scheduled regulations declare them non-compliant.

In the rush to digitize records, however, few are looking beyond 2014. Healthcare records should last as long as the patients they describe, at a minimum. An infant’s birth records should be available 100 years later. But few digital storage methods are designed for more than 10 years’ longevity, and some are shorter. Systems that store digital health records have many components, and all are potentially troublesome beyond eight to 10 years:

• Mechanical storage media—disks, tapes, and others—lose integrity and degrade.
• Operating systems evolve, and backward compatibility diminishes. Similarly, format preferences evolve, leaving limited accessibility to older formats. The same can be said for application software.
• Hardware becomes obsolete. For example, in 1991, a major WORM disk manufacturer guaranteed their 12-inch disks for 99 years. While that claim cannot be verified for another 80 years, the hardware to play those “dinosaurs” is difficult to find.
• Since EHRs are private and must be secured, what is the likelihood that future generations will retain decryption techniques and passwords for protected digital records?

These issues are not futuristic. On July 19, 2010, South Shore Hospital in South Weymouth, Mass., reported the loss of 800,000 backup files of personal, health, and financial information for patients, physicians, and others dating back to 1996.  Hospital officials downplayed the likelihood that these files could be used for crime, even if they fell into the wrong hands. As reported in eWeek on July 21, South Shore Spokesperson Sarah Darcy said, “It would take special equipment, special software, and special knowledge and technical skills to access any of the information on the files, let alone decipher it.”

Left unasked is whether the hospital itself had the resources, knowledge, and skills to render these files readable. The issue of long-term preservation of digital health records is rarely discussed today, but recovery and maintenance of those records looms as a major challenge to successive generations. Today’s babies may eventually wish that their parents and grandparents had created at least a plan to ensure the longevity of vital health records.

In terms of EHR, unquestionably this is a time of great progress. The trend to digital records grows exponentially. Hardware and software empires will be built, and some will be lost. Eventually, standards will emerge, and solutions providers will consolidate.

Certainly, patients will benefit from this process. Whether money will be saved is yet to be seen. The final chapter will not be written until the solutions created today have withstood the test of time.

Check out our Healthcare Information Management section for more information or to find companies that provide these products and Services.