Many health experts say that, to save money and improve care, the United States needs to get past paper records and frequent visits to the doctor.
And to encourage the switch to standardized electronic records, the federal government has begun offering incentives to providers.
But the push to innovate has been met with some resistance. Dr. Jacob Reider is deputy national coordinator of health information technology for the Department of Health and Human Services.
At this week’s annual Cerner conference, he told Heartland Health Monitor’s Alex Smith that his work is about more than swapping the manila envelope for cloud storage.
I hear a lot of talk about the need for innovation. What is the need from the patient's side?
If we look at the way that we provide health care services in this country, it’s still primarily locked into the way that we’ve done things for the last two decades. And a lot of those activities rely on paper processes. And so we can innovate by thinking about things differently by using technology to change the conversations. Literally change the conversations, if that means using a video chat with a health care provider rather than driving across town and skipping work or taking a kid out of school.
So we can use telecommunications tools, we can use information technology to remind us to do the things that we might not remember to do. So I got an automated reminder from my health care provider that I needed a flu shot. It was a good reminder for me, and it caused me to go get one. Those are the kinds of things that are obvious in other technical domains and not yet really part of the infrastructure we’re using for health care yet today.
What role can the Department of Health and Human Services play in moving that innovation forward?
So innovation happens when people are pressured to do certain things, right? Pressured by economic factors, pressured by incentives that motivate us to move forward and think about things in a different way and also standardize. So the government establishes standards. There are electronic standards that we have established that allow these systems to communicate with each other. There are standards of care that we’ve established so that health care providers know what they’re expected to do in terms of certain quality expectations and other things. So the government’s role is to motivate folks to be creative and think innovatively and yet, align by certain technical, safety, care delivery, quality standards so that everybody gets the same quality of care.
Where do you see the biggest resistance to that kind of standardization?
Resistance to any innovation comes from the incumbent methods, incumbent processes. And so if organizations, say for example, are making lots of money off the current methods of providing care, sometimes we in the government talk about this as paying for volume rather than paying for value. If it’s better for me and the payments on my mortgage to cause a patient to come to the office, even if they don’t need to come to the office, then we’re motivating folks to do the wrong things. So what we need to do as a government and as a nation is to be creative about how we compensate for services. Because today still, better than half of care is provided in this so-called ‘fee-for-service’ manner.
In discussions of electronic health records, I’ve heard concerns — especially from people in Missouri — about privacy. How do you address privacy concerns?
Sometimes digital systems can provide privacy risks, security risks, that are greater than the physical risks of, say, a patient record. Yet at the same time, we know that, in fact, the digital records can be more secure than paper records if we think about a paper record and cleaning services or various people who not only have physical access to records but fax machines, copy machines and so forth. So digital systems have greater security frameworks, such as audit logs or enhanced username password security requirements, so that not only do we know that the records are safe, but we have a way of tracking who had access to certain data when and where. And so you may have seen once in a while somebody who doesn’t have the authority to see a certain person’s records, say a V.I.P. in a Hollywood hospital, those people are found instantly and then often relieved of their work responsibilities.
So security’s very important. The federal government has explicit requirements for how these systems are built for the protocols that are used to implement them and monitoring of access logs so that we can make sure that patient information is always protected.
How long do you think it will take before we have a nationwide, standardized system of record-keeping and communications for health care professionals?
I would argue that we already have many components of this already standardized. I suspect that a large majority of the people who are listening to this broadcast have received an e-prescription. That’s happening now hundreds of millions of times every year in this country. And I would argue that that’s a piece of an enhanced, health IT-enabled care delivery system. And so, when will it be complete? I would argue never. But we will get closer and closer to perfection over the course of time.
