It is crucial that the Federal Government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy. More specifically, PCAST recommends that the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services develop guidelines to spur adoption of such a language and to facilitate a transition from traditional electronic health records to the use of healthcare data tagged with privacy and security specifications.Summary of report:
- Great potential for health IT but held back because 80% of US docs have no EMR system.
- Even where EMRs do exist they are rudimentary and lack interoperability.
- Areas where IT has had a transformational effect have employed simple standards and developed new products to knit together fragmented systems into a unified infrastructure. [Examples? Google, which knits the web into a unified search engine. Not iTunes though, which is anything but disparate]
- Health IT is a long way off this goal. Current EMRs are highly proprietary; inward looking; generate legitimate privacy concerns; and are oriented towards administration.
- Meaningful use rules have been helpful but establishing a framework for information exchange is vital to accelerate progress.
- Standardized records and SOA aren't the solution
- Health IT should use the disruptive effects of the Internet to move forward, and not wait for EMRs to evolve.
- A universal exchange language and the associated infrastructure are priorities. Both need to be funded centrally.
- Tagged data elements, accompanied by meta-data, are key
- The indexing and retrieval of metadata-tagged data, across large numbers of geographically diverse locations, is an established, highly developed, technology—the basis of web search engines, for example.
- The approach that we describe requires that there be a common infrastructure for locating and assembling individual elements of a patient’s records, via secure “data element access services” (DEAS). Importantly, this approach does not require any national database of healthcare records; the records themselves can remain in their original locations. Distinct DEAS could be operated by care delivery networks, by states or voluntary grouping of states, with possibly a national DEAS for use by Medicare providers. All DEAS will be interoperable and intercommunicating, so that a single authorized query can locate a patient’s records, across multiple DEAS.
Some other points in the review:
- More than 3 million Kaiser patients are registered to access their health record online. Over 100,000 access the system on a given day, reducing office visits by 26%
- Google and Microsoft, the two largest vendors of web-based PHRs, recently agreed on mechanisms to enable the free exchange of information between their respective PHR systems, and others may follow.
- US physicians who adopt electronic records by 2014 can qualify for Medicare bonus payments of up to $44,000
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