Back Page: Around-the-clock access to health info: Why is it so hard?
Remember how we used to have to run to the bank before closing time to cash a check? Then " seemingly overnight " a magical machine began giving us money. With nearly a half-million automated teller machines in the United States, access to our money is just inside the nearest convenience store.
Why can't health information be accessed that easily? There are two reasons: First, because what appears to be a rapid shift in the banking industry was actually 50-plus years in the making. Second, because what makes ATMs function " a complex dance of transactions " is simple compared with health information.
Although there are millions of automated banking transactions, they boil down to eight key transactions that involve numbers. That's it.
Health information could be accessible around the clock if all the data we had to deal with had only two digits to the right of the decimal place. Unfortunately, health information is language-based and complex.
For it to flow from one setting to another around the clock, four thorny issues must be addressed: patient identifiers, privacy/security, medical vocabularies and payback.
Banks address identification issues by requiring users to have an ATM card and personal identification number to access accounts. Health care doesn't have that luxury. Patients may come to a clinician unconscious or disoriented; people may feel shame, embarrassment or fear. There are many reasons why patients can't be relied on to always correctly identify themselves.
A standardized medical vocabulary is another thorny issue. Specific clinical descriptions allow providers to diagnose and treat patients. At the same time, patients need everyday language to understand the ramifications of their health conditions.
Also, health care consumes 16 percent of our country's gross domestic product. That translated into $11.7 trillion in 2005. By 2015, it's estimated that this percentage will grow to 20 percent. It's the largest component of the U.S. economy, yet much of those costs are wasted dollars. Tests are rerun, duplicative prescriptions are filled, unnecessary procedures are performed, mistakes are made " all because clinicians don't have the information they need to make efficient, effective care decisions.
A study published in the Journal of the American Medical Association examined 1,614 primary care records and found that clinical information was missing on 13.6 percent of visits. The missing information had a significant potential to adversely affect patients. Rand Corp. found that patients receive appropriate care only 55 percent of the time. Preventable infections patients acquire while at a medical facility cost $4.5 billion annually and contribute to more than 88,000 deaths annually. The Centers for Disease Control and Prevention report that every year 16.7 million visits to physicians by elderly patients result in prescription errors. In 1999, the Institute of Medicine stated that preventable medical errors cause 45,000 to 98,000 Americans to die and 1 million Americans to be injured each year. To achieve the same level of fatalities, four to eight 757s would have to crash each week with no survivors.
The ubiquitous ATM took years to create. Health care is roughly 25 years into its creation of around-the-clock secure access to electronically transmitted information. Let's not take another 25 years to weave it into the American health care landscape.
Smith is executive vice president of the Healthcare Information and Management Systems Society.