IT healthcare: a Beacon in the night
If the constitutionality of the Affordable Care Act, passed by Congress in 2009, is upheld this summer by the Supreme Court, it is expected that 30 million currently uninsured Americans will be added to the nation’s already overburdened and crumbling health care system. Despite tremendous advances in science and technology within the medical field, the United States touts the most expensive health care system in the world per patient, despite 45 million people remaining uninsured and being ranked only 37th in the world for quality of care and life metrics. A key aspect of managing the onslaught of patients will be cutting cost inefficiencies and streamlining care beyond the emergency room, which the Mayo Clinic has already found success with. Another is digitizing the mountain of data and records that American patients generate, namely putting people’s health information in malleable databases that can move with a patient, and even be updated on mobile devices. The benefits? Everything from eliminating redundant boxes in drab workflow charts, reducing errors, cutting costs, and improving real-time diagnostics.
In 2009, the U.S. Department of Health and Human Services took a major leap towards implementing IT infrastructure into medical establishments nationwide by contributing $235 in federal funding to jump-start a Beacon Community Program in 15 select communities. $220 will be divested in a diverse group of communities, including rural and underserved communities, to fortify their IT infrastructure and health information exchange capacities, which includes privacy and security measures. The remaining $15 will be used to assess the success of the program and provide technical assistance. The overarching hope of the Beacon program is three-fold: implementation, utilization and extension. Initially, existing IT infrastructure will be built off of and integrated into hospital settings to demonstrate cost savings and better care. Improvement of electronic health records (EHRs) to above national rates is a concomitant goal. Finally, looking ahead, lessons from the Beacon Program will be integrated with the recently established Office of the National Coordinator for Health Information Technology (ONC) to implement wide scale EHR use nationwide.
Two years after its implementation, the Beacon Program is showing signs of early success. A progress report offered up by the HHS funding committee includes increased internal collaboration between established Beacon Communities, improvement in the Minnesota community on electronic capture of patient reported outcomes, and IT-enabled medical home models as safety nets in still-ravaged New Orleans. Less than a week ago, a San Diego-area emergency physician was one of 82 representatives from the Beacon program whose work towards progress in health IT was recognized at a White House ceremony.
Nevertheless, obstacles and questions remain before EHRs become ubiquitous within the national health care system. Safety and protection of personal data is the paramount concern, with Administration officials admitting that oversight of EMRs is moving at a crawl since the launch of the Beacon Program. And while EMRs have been universally praised for their convenience, the Health Insurance Portability and Accountability Act, passed in a pre-Internet 1996, allows for very broad access to patient records for researchers, a definite concern that must be addressed before all medical records go digital in 2014.
Dr. Leslie Saxon, Founder and Executive Director of the University of Southern California Center for Body Computing, and the Chief of Cardiovascular Medicine at the University of Southern California Keck School of Medicine, is a vocal proponent of the benefits of technology integration in medicine, believes we can take this one step further – personalized medicine, where people are active participants with their doctors. By integrating devices such as iPhones, iPads, androids, etc. with medical records and health assessments, patients could be put in charge of monitoring their own insulin or blood pressure, for example, and doctors could reach out the moment they see a worrisome result. Likewise, patients going to a regular check-up can already give a wealth of information to their doctor, which will aid in correct diagnoses and a more personalized per-patient approach. Dr. Saxon, who elucidated many of these ideas in a recent TEDMED talk, is one of the founders of a big data “life analytics” project called EveryDayHeartbeat.org. By 2013, the goal for the project is to create a system in which anyone can log-in and start recording their health narrative through their wireless phone, a sort of Genome Project for health care—identifying patterns, disease clusters, epidemiological trends and giving people control over their own health. Interestingly, recording 6 billion people’s heart rates will consume 1 terabyte of information a day, 1000 less than the movie Avatar.
It is clear that there is an undeniable momentum for moving health care into the 21st Century in terms of technology, access and convenience. The benefits to be gained from such transparency are innumerable, both in how we receive health care, as well as increased mobility for people when they move from doctor to doctor. Indeed, hospitals that computerize their records show fewer patient deaths than their analogue counterparts. However, with Microsoft, Google and other technology giants managing health care information, clear oversight must be established for patients’ privacy rights and violation ramifications. Furthermore, a Dartmouth study showed that medical workers routinely share private medical records amongst each other using peer-to-peer file sharing programs, raising concerns about easy access and the integration of nonsecure devices to record such data. Rather than marching medicine into the information age, we should ease into it with precaution and safeguards.