Drs. Emmanuel Reyes, Becky Swensen and Tanzina Zaman access the VA's electronic health records system. (Staff)
The Indian Health Service (IHS) is in the midst of spending $14 million to upgrade its electronic medical records, and acting Chief Information Officer Dr. Howard Hays is already calling it money well spent. “This is our most pressing initiative,” he said.
IHS is working to meet the Meaningful Use standard, a government effort to ensure medical providers have digital records capabilities and are actually using them. Hays is drawing heavily from IT tools to make it happen, including a patient-facing records portal, a secure messaging system for patients and providers, and a new system for calculating quality measures.
In the realm of health care IT, such initiatives are just the beginning. Across a changing landscape, government is driving development and reaping the benefits of a range of new technologies meant to enhance care and deepen the ability to share information across the spectrum of patients and providers.
Improvements are needed, according to the 2013 state of the industry report from Workgroup for Electronic Data Interchange (WEDI).
Health care still lacks a uniform way to identify patients across providers. There’s still no easy way to capture and share clinical information. Few tools exist to engage the patient outside a clinical setting.
“I don’t think technology is the barrier in any of this,” said WEDI CEO Devin Jopp. With technology drawn from smartphones, electronic banking and other media, it ought to be possible to bump medical intelligence up a notch. Federal agencies can help. “If the federal government moved to embrace and test these things, it could shift the privacy industry to follow suit.”
Government is indeed making such moves.
Info for all
Take for instance the Blue Button, originally a project in the Department of Veterans Affairs and now housed in the Office of the National Coordinator for Health Information Technology (ONC). The concept is simple: Patients click the Blue Button icon to get easy access to their medical records. Then they can approach any medical provider with a full suite of information.
The Blue Button already is offered through VA, Department of Defense and the Centers for Medicare & Medicaid Services. Some 500 doctors, hospitals and insurers have also signed onto the project.
“Many physicians are frustrated by short visits with their patients — not a lot of interaction time. So if the patient can get their information ahead of time and think about it and formulate questions, that can really maximize the value of that office time,” said Lygeia Ricciardi, director of ONC’s Office of Consumer eHealth.
Some of the most important IT work in health care these days is also the most boring. Developing a lexicon to standardize terminology rarely generates much interest among consumers, but it forms a vital link in the chain of technologies that promise to help government medical initiatives run smoothly.
ICD-10, for example, a federally mandated initiative that will, among other things, help Medicare to speed claims, will add some 70,000 new medical codes to the existing list, making records significantly more precise.
“It tracks the history of why you went to the hospital. It allows the provider to accurately categorize why the patient is in the hospital, which allows the payer to more accurately pay based on this increased information,” said Michael Riley, vice president at MCPc Inc., a technology consultancy and integrator.
Building the new lexicon is daunting. “It is a manual effort. Somebody has to actually sit down at a computer and program in all the different codes. It’s very resource intensive,” Riley said, noting that Medicare is helping to move the effort forward. “They are supplying a decent framework, they are making recommendations for best practices to help the health systems across the finish line.”
Diagnosis on the go
While new terminology may help the wheels turn on the reimbursement side, other IT advances go right to the heart of emerging health care: better patient outcomes.
Take for instance VisualDx, a mobile app that the VA uses. It has been accessed about 4 million times.
“It’s an extension of a doctor’s brain, just like a stethoscope extends your ears. It doesn’t make diagnosis, but it is a decision-support tool,” said Noah Craft, chief medical officer at Logical Images, which makes the app.
The technology is much the same as that used in Google apps and other cross-referencing layered information aggregators. The doctor enters a description of symptoms and gets back photos that meet the description. Each likely disease state is correlated to a list of possible diagnoses, risk factors, treatments and other key elements meant to guide physicians.
“When you look across all of medicine, about 20 percent of diagnoses are incorrect. For VA, as both provider and insurer, they actually care deeply about getting the diagnosis right,” Craft said.
Making sense of it
All of this amounts to reams of data, endless codes and terms, vast vaults of medical data, an avalanche of transaction data and patient records. Looking across the federal landscape, the ongoing big data revolution may ultimately herald the biggest changes.
Government is getting better all the time at implementing large-scale analytics, said Michael Jackson, director of health care and government strategy for Adobe. That capability may signal a transformative moment in the role government plays in the health care landscape.
One such example comes from the Health IT Dashboard, which is making data sets available for third-party integration. “They don’t pretend to be developing products or solutions. What they are saying now is: As the federal government, we have terabytes of data from public health to population management, and we want to make it available in standardized bite-sized chunks,” Jackson said.
“It speaks not just to the data itself. It speaks to the government’s intention to move away from just a store-and-ignore data philosophy,” Jackson said. “Now the philosophy is: We have this information, let’s open it up and make use of it.”■