WASHINGTON, DC—For physicians in the 21st century, “information is about electronic health information systems,” said David Blumenthal, MD, MPP, National Coordinator for Health Information Technology, speaking here at a news briefing sponsored by American Journal of Managed Care, an event held at the National Press Club. “HIT is about the daily work of patient care, being sensitive to our clients, and empowering them to be better at what they do. It is the underpinning of health reform,” Dr. Blumenthal said.
Panelists called HIT an important tool to improve patient safety, diagnostic testing, treatment outcomes, prescribing accuracy, medication adherence and coordination of care.
“Health information technology is changing the way medicine is practiced today,” said the moderator of the briefing, Sachin H. Jain, MD, MBA, Senior Advisor to the Administrator of the Center for Medicare and Medicaid Services (CMS). “Historically there hasn't been a business case for HIT; HITECH [the Health Information Technology for Economic and Clinical Health act, passed as part of the American Recovery and Reinvestment Act of 2009, which authorized up to $27 billion in new funding to support the “meaningful use” of HIT] has created the business case.”
Katlyn L. Nemani, a first-year medical student at Tufts University, gave a personal glimpse into how better use of HIT might have helped her family when her sister was diagnosed with Hodgkin's lymphoma. Ms. Nemani described a disjointed nightmare scenario of driving from doctors' offices to the hospital and back to obtain her sister's paper records, some of which were lost and some of which did not come through on faxes.
“Dealing with a paper system was horrible,” she said. “From a patient perspective electronic records can really improve a patient's life.” From a professional standpoint, said Ms. Nemani, she wants to study whether there are geographical patterns of cancer clusters. “Being able to see those patterns is next to impossible without an electronic system,” she said.
Another speaker, Denenn Vojta, MD, Senior Vice President of the UnitedHealth Center for Health Reform and Modernization, made the point that HIT can be used for large-scale, cost-effective prevention and disease-control management programs. Citing the challenges of obesity and diabetes, she described a diabetes prevention and control program launched by UnitedHealthcare. And yes, she said in response to a question, the program could serve as a model for other chronic diseases, such as cancer.
Pediatric cancer, she said, is the model for excellent, family-centered care in oncology. “Wouldn't it be great if reimbursement would be for the very best care? An effective HIT infrastructure could help make that happen.”
By providing medication reminders to patients, HIT could help improve adherence, said William Shrank, MD, MSHS, Assistant Professor of Medicine at Harvard School. Currently, improving patient medication adherence is a greatly underused application of HIT, but “we all recognize there's a real opportunity here.”
4 Key Principles
HIT can be coupled with comparative effectiveness research (CER) to help advance patient care, said Amol Navathe, MD, PhD, Medical Officer and Senior Program Manager, Comparative Effectiveness Portfolio for the Office of the Secretary, US Department of Health and Human Services. He pointed to four key principles for the advancement of CER:
- Use of data as a strategic asset;
- Leveraging public/private partnerships;
- Building robust, scalable technology platforms;
- Coordination of activities across government agencies.
Asked by OT how HIT and CER can be coupled to address differences in disease subpopulations, Dr. Navathe said the completeness of the data is key. “As electronic health records collect these data, we can explore different methods which can address subpopulations,” he said.
In an interview, Joan S. McClure, MS, Senior Vice President for Clinical Information and Publications for the National Comprehensive Cancer Network, said she is very happy to see HIT assuming an increasingly important role in health care delivery. “I think it's going to be very beneficial,” she said. But, she noted, there are special challenges for HIT in oncology because “oncology is very heterogeneous, and you're really talking about very discrete disease entities.”
There are also logistical and process challenges: “From an oncology perspective, most of the data on a patient are in the physician notes—Getting the information out is a challenge. That's a big issue in oncology; how do you get to the data that you need?”