Julia Weatherby, e-business consultant
IBM Software Services for WebSphere
The top experts and students in medical informatics gathered a few weeks ago at the Annual Symposium of the American Medical Informatics Association (AMIA) in Washington, DC. Determined to expand my knowledge in this field, I took the opportunity to attend. For me, the highlight of the conference was hearing Dr. David Brailer speak on the federal role in promoting health IT adoption. "If this is the decade of health IT, this is the month of health IT."
Brailer noted that much of the groundwork his office had covered in the last year was coming to fruition in the last several weeks. On October 6, the government established three partnerships to address EHR certification, interoperability standards, and address variations in privacy and security practices.
He also outlined a two-pronged strategy:
- a long-range goal of developing the infrastructure for the National Health Information Network that President Bush has called for (IBM recently won part of that important contract)
- A shorter-range plan to help the public appreciate the practical value of electronic health in applications such as e-prescribing, chronic disease management and biosurveillance.
Dr. Brailer noted that the development of electronic health will be a continual learning process, with opportunities to improve upon the infrastructure through cycles of revision and refinement. He seemed optimistic that we would learn from early failures. But he expressed concern that if the plan lacked short-term successes, Americans might lose interest and the effort could lose momentum.
While Brailer's strategy makes sense in broad terms, it occurred to me that in the effort to achieve short term successes, we must be sure not to compromise on the infrastructure, in terms of security and reliability. The public's trust in an electronic infrastructure for healthcare will need to be nurtured carefully and patiently, pardon the pun. Winning that confidence will be incremental, but it could be lost very quickly if we aren't prepared to deal with bumps along the way.
During the conference, the federal Commission on System Interoperability released a report, Ending the Document Game. We were fortunate to hear details of the report directly from those on the Commission on the day it was made public. The report contains the Commission's strategy for the adoption and implementation of electronic health records (EHR). It outlines fourteen steps to achieving interoperable health records, divided into three categories of adoption, interoperability and connectivity.
One of the recommendations calls for the Department of Health and Human Services (HHS) to create a public awareness campaign to educate consumers and providers. Part of the report includes 68 colorful pages of "Patient Stories" that aim to describe how interoperable health records will serve the needs of consumers as well as medical professionals.
This section of the report paints a fairly rosy picture of electronic health records, but doesn't seem to adequately address healthcare consumers' primary concern about EHRs, namely security and privacy. Although all five of the connectivity recommendations touch on security and privacy, this section of the report doesn't address either issue until page 43.
And even there it falls down. While noting that paper records are not particularly secure, the issue is casually put aside in this call-out quote from a doctor: "I’m not well-versed in Internet security or in electronic record security, but I don’t think it should be a big concern." Is this supposed to assure the public that EHRs will be secure and private?
While the report might be wanting on that not-so-small point, the conference was definitely not lacking for compelling sessions, especially those on planning for and managing disasters with health IT, and lessons learned implementing Computerized Provider Order Entry (CPOE). I caught a great demonstration of the VistA open source EHR stack and was impressed by the sophistication of the software, which appeared to do a good job of integrating patient data with medical images and lab reports. The graphical interface seemed to be user friendly and easy to navigate. I would like to learn more about its technology and the open source community supporting it.
Finally, attendees also got a chance to tour the National Library of Medicine, where we were introduced to various medical informatics projects, such as using Natural Language Processing to extract information from MEDLINE articles. What was most inspirational for me was the exhibit called Changing the Face of Medicine which portrays the lives and accomplishments of women in medicine.
I learned that the Apgar score given to newborns at birth was created in 1952 by Dr. Virginia Apgar, an anesthesiologist. The exhibit showed that some of these women's greatest contributions were made outside the medical setting. Dr. Barbara Barlow researched the causes of the children's injuries she saw everyday, and then developed programs which dramatically reduced the number of injuries from dangerous playgrounds and falls from high-rise buildings. This exhibit is a great resource for those of us who educate or mentor aspiring students.