Healthcare actually pushed the Iranian elections out of the top news slot this week. Most of the attention has been on the administration’s efforts to establish a government insurance plan of last resort. But in the background, the health information technology (HIT) effort continues to boil along, with a lot of action and not much clarity emerging on standards for electronic health record (EHR) software.
Dr. John Halamka, noted CIO of CareGroup Healthcare System, reported on the second meeting of the HIT Standards Committee, of which he is a member. The committee is currently engaged in a four-dimensional exercise: drilling deep into the information space that healthcare inhabits to understand what data in what format has to be interchangeable, all the while trying to understand how these standards will develop over time. It’s a Herculean task, even at the 50,000-ft. level, and I’ll be very interested to see where they are able to make progress and where they stall. Halamka points out that already people are beginning to see that EHR won’t progress unless complementary initiatives like lab results data standardization also proceed apace.
Meanwhile, the standardization picture is far from clear. Neil Versel is hearing rumors that CCHIT may be replaced or augmented as the certification body for EHR software. The presumptive favorite body to certify may be sidelined or augmented by the Office of the National Coordinator for Health Information Technology, the federal agency overseeing the Recovery Act initiatives in electronic healthcare. One hospital IT director I’ve spoken with says he expects the Joint Commission that accredits hospitals to step into the fray. That might be a culture shock, as the Joint Commission has a reputation for rigor in its clinical inspections that could be a rude awakening for software vendors.
The next few months will hopefully clarify just what IT needs to do to demonstrate meaningful use of healthcare IT. Meanwhile, IT organizations are not standing still. Alex Barrett wrote recently about Boston-based Beth Israel Deaconess Medical Center’s EHR project to get private physicians integrated into their systems. BI-Deaconess is making creative use of server virtualization to build an infrastructure that can grow and adapt as it gains acceptance and use. This is not an insignificant problem for architects who face uncertain usage targets and unknown ramp up times.
Chris Griffin documents an interesting culture shift in healthcare IT, which he describes as a “culture that puts a big emphasis on software applications, rather than on hardware and a holistic view of the computing environment.” That’s probably a dysfunctional approach for IT departments that will face increasing pressure to store more patient data from imaging and other diagnostic procedures as well as for longer and longer times due to regulatory compliance requirements.