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.

Clueless in Healthcare

Mark Metherell is reporting that patient control over what goes into their electronic medical records faces resistance from some Australian medical leaders, who are calling for a delay, to what they call “the potentially hazardous patient control feature”. Steve Hambleton, the vice-president of the Australian Medical Association said, at an Australian Health Department summit conference on e-health in Melbourne, that patients wanting to hide their treatment for depression, for example, raised the possibility of a dangerous medication interaction if the patient was later prescribed painkillers by a doctor unaware of an earlier anti-depressant prescription. Such information needed to be available to all doctors. ''It should only be able to be changed by doctors who understand the implication of what is recorded - and this can certainly be done in consultation with the patient.” In addition, he said that patient control of records should be held off until the electronic records transfer system had won the confidence of doctors and patients. However, the right of patients to hide elements of their records from some health professionals who do not need to access the information has been hailed by the Australian government as a central element of the e-health plan, due to start in July 2012. Australian Health Minister, Nicola Roxon, told the conference that privacy was a key concern and the electronic records would be ''truly personally controlled''.
While there may be legitimate reasons for allowing providers access to patient records against the will of the patient, the scenario that Dr. Hambleton suggests, doesn’t fit the bill. The problem that he suggests may occur, is indeed already happening, without Electronic Medical Records. It is well known that some patients simply don’t tell their providers everything that they could. Sometimes, the physicians have “no clue” regarding the missing information and sometimes they are suspicious or even in fact are aware that the patient is not telling the full story. The physicians are still responsible for the decisions they make regarding what they know and do for these patients. This is not a phenomenon created by Electronic Health Records. Those physicians that believe patients will always tell them everything, once everyone gets an Electronic Health Record, are simply mistaken. Physicians have and will remain responsible for what they do or what they should have done, given the information that is available to them. Electronic Health Records will not change this reality. If the Healthcare system persists in pursuing a course that excludes patient access and control of their personal health information, it will undermine patient trust in the Electronic Health Record system for some, in the same way that some patients today, have problems trusting the current system. In fact, it may be, that in the future, patients will deem it to be in their best interest, to withhold information from their providers, because of the risk the disclosure might have on their future insurability! If the healthcare system wants full disclosure from its patients, it should be willing to give full control of the health information, to their patients. Only then, can the vision of equitable, patient-centered, shared decision making, which is so often espoused as the ideal, have any chance of becoming a reality.