Federal work groups aim for better electronic health information systems

Two federal panels examine issues related to the future of a system that links patients, physicians and the public health system.

By Victoria Stagg Elliott, amednews staff. July 31, 2000.

While on a camping trip, 66-year-old Joyce Peters was stricken with severe stomach and chest pains. Because she had had a bout of angina five years ago, she was wearing a medical alert system with a built-in positioning feature that immediately reported her distress to both the closest paramedic team and her cardiologist hundreds of miles away.

By the time the paramedics reached her, they already had received electronic transmissions of her medical history. At the hospital, the doctor, with Peters' permission, was able to access her full medical record and update it with new information.

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The next day, Peters felt well enough to go back to the woods, but forgot the instructions from her doctor. No problem. She used her cell phone to log on to her personal health record and enjoyed the rest of her vacation. Meanwhile, the local health department used information collected from her chart and that of other patients' records to recognize that a cluster of tourists had become ill after being in the same part of a local park. That information led to a discovery that a punctured sewer line was contaminating the water supply to nearby restaurants and water fountains.

Does it all sound like a dream world? Right now, it is.

Joyce Peters does not exist. Nor does the infrastructure her treatment required. And for the moment, this scenario exists only in a report written by members of two Health and Human Services Dept. panels -- the Health Statistics for the 21st Century Work Group and the National Health Information Infrastructure Work Group. Their efforts are meant to focus attention on what a modern health information infrastructure should look like and what it could achieve if it took full advantage of modern technology.

"Information technology in health care is underutilized," said John R. Lumpkin, MD, MPH, director of the Illinois Dept. of Public Health and chair of the information infrastructure work group.

Doctors and public health officials on these committees are imagining a world that both allows appropriate access to a single health record and protects patient privacy. They envision links between private health records and regularly updated information about drugs and diseases that would set off warnings when a drug may not be appropriate for a particular patient. They also see a world in which doctors fill out one form rather than many and information is automatically sent to the appropriate agencies.

Advancing these concepts, however, is hampered by the challenge of integrating local information systems, finding financial support and developing the technical literacy required to utilize such systems, according to panel members and other experts attending a July 10 hearing in Chicago.

"It'll be easy to establish a national system, but it'll cause havoc in the systems that are out there now," said Thomas Conway, senior policy analyst in the AMA office of electronic medical systems. "And it'll be difficult to collect all the data."

Other barriers cited included convincing patients that the information was needed and would not be misused. "Protecting privacy and the confidentiality of personal health data is of the highest importance," said Richard B. Warnecke, PhD, director of the Center for Health Services Research and the Health Policy Center at the University of Illinois-Chicago. The systems also must be easy and cost-effective for both patients and physicians to use.

Other members of the committees warned that underutilized health information was hazardous to economics and patient health and that a new infrastructure was vital. "We don't analyze data because the resources to analyze information are costly," said Patricia Merryweather, vice president of the Illinois Hospital and Health Systems Assn. Proper analysis, she said, could help hospitals, for example, figure out ways to reduce the significant expense of increasingly large numbers of patients accessing health care through the emergency department.

More hearings will be held within the next year. A final report is expected in the spring of 2001.

ADDITIONAL INFORMATION:

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Interim report of the National Committee on Vital and Health Statistics Toward a Health Information Infrastructure (http://www.ncvhs.hhs.gov/NHII2kReport.htm)