HIT resistant strains

The recently released President’s Council of Advisors on Science and Technology report entitled, “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward,” calls upon the Federal government to facilitate the widespread adoption of a “universal exchange language” that allows for the transfer of relevant pieces of health data while maximizing privacy. Reflecting input from industry and IT experts, privacy groups, healthcare professionals, and others, the report provides specific recommendations for cultivating an information technology (IT) ecosystem that facilitates the real-time exchange of patient information in order to modernize diagnosis and treatment, improve public health, enhance the privacy and security of personal data, and create new high-technology markets and jobs while catalyzing healthcare-related economic reforms needed to address our Nation’s long-term fiscal challenges. The report finds that the technology for creating the necessary infrastructure and exchange language is already proven and available. But since the development of those systems is not likely to be a profitable venture in itself, the Federal government should facilitate their creation and then leave the private sector to develop products that build on them. The full report can be found at http://www.whitehouse.gov/ostp/pcast.
Despite providing some very useful and important perspectives, the report also drops the ball in a few key areas. The report appears to envision the bulk of healthcare in the future, and thus the majority of the benefit of Health IT, to be occurring in the context of a clinical encounter with a provider. With chronic diseases being the major health problems in our country, most people will have their illnesses for many years and see their healthcare providers for relatively short periods of time over the course of the lifespan. If Health IT only helps in these brief episodes, we need to look for other more robust solutions. The report also seems to assume that, with appropriate financial incentives, providers will use Health IT appropriately and largely achieve maximum benefits. There appears to be little attention or recognition to the issues of Health IT usability or patient safety. Even the world’s best medicines are totally ineffective if providers do not prescribe them or patients do not take them. In fact, if they are prescribed or taken inappropriately, it could be worse, they could lead, as in the case of many antibiotics, to drug resistance and superbugs which are even harder to treat. If we fail to pay attention to Health IT usability issues, providers and patients may use them inappropriately or not at all, either of which would likely increase the risk of poor patient outcomes and inadvertent patient harm. These issues are only magnified as we consider the fact that, in the future, more patients and caregivers will be using Health IT to manage their own health or the healthcare of a loved one. These oversights could not only lead to harm, but also increase disparities if the impact of the problems are distributed disproportionately across patient or provider populations. We must, as the president’s council recommends, build a robust information-sharing infrastructure, but we should not create new strains of Health IT resistant superproblems that facilitate poor outcomes in the process.