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Nutrition Informatics Blog



Health IT Roadblocks: Glass Half Full or Half Empty?

This blog is all about health care, nutrition and information technology.  Today, I am responding to an article in the Wall Street Journal: A Major Glitch for Digitized-Health Care Records: Savings promised by the government and vendors of information technology are little more than hype. (By Stephen Soumerai and Ross Koppel).  While there has been a great deal written about electronic health records (EHRs) and health information technology (health IT), it is important to understand the big picture.

In short, the authors (one of whom I know) propose that the government and EHR vendors have pulled the wool over our eyes and that health information technology (HIT) is a sham.  I have written for over two years about the Health Information Technology for Economic and Clinical Health –or HITECH Act that they reference, so I will assume readers are aware of this.

Clarifications on points made in the article:

Author Comment: “Thousands of American physicians and hospitals that fail to buy and install costly health IT…will face penalties through reduced Medicare and Medicaid payments.”

Fact:  The 2009 legislation referenced is both the “carrot and the stick”; these hospitals also qualify for incentive payments. The incentive payments are exactly that—a method to incentivize health care providers and hospitals to adopt health IT.  It also does penalize those who do not adopt health IT after the incentive periods are over.

Fact: The U.S. is the last country in the world to adopt health IT, spends more than any other country on health care and has well known quality issues in spite of high expenditures.

Fact: The nudge for this legislation was prompted by several Institute of Medicine studies which identified the high incidence of medical errors in the U.S. and recommended adoption of health IT so that health care could be improved.

Fact:  Dietitians are not included in this legislation (nor or any other ancillary provider.) They will not receive any Medicare/Medicaid penalties or incentives.

Author Comment: “With a few isolated exceptions, the preponderance of evidence shows that the systems had not improved health or saved money.”

Fact: Health IT adoption rates have been low, as acknowledged by the authors, until the 2010 reporting period for the regulations began.  This needs to be measured over time but measurement of dollars saved in the past does not reflect new adoption progress.

Author Comment: “Instead of demanding unified standards, the government has largely left it to the vendors, who declined to cooperate, thereby ensuring years of non-communication and non-coordination.”

Fact:  Vendors have participated in the development of standards and policy.  The Final Rule for Stage 2 “Meaningful Use” under this legislation identifies which standards and vocabularies that must be used by the health care system.  There is always room for improvement, however.  Greater collaboration on health IT functionality and usability would help greatly (although most vendors are careful to protect their own intellectually property.)

Fact: It is the exactly this mandate for specific standards that has the Academy working around the clock to integrate the International Dietetics and Nutrition Terminology (IDNT) and the Nutrition Care Process (NCP) into the required vocabularies and standards.  IDNT will eventually become part of mandated vocabularies.

Fact:  There were more than 200 health care/medical vocabularies in 2009; this legislation has identified a handful of vocabularies and a dozen or more specific standards to promote the “data following the patient.”  This is progress—and also—like all rapid change –is painful to those enduring it. 

Author Comment: “It is already common knowledge in the health-care industry that a central component of the proposed health IT system—the ability to share patients’ health records among doctors, hospitals and labs—has largely failed.”

Fact: “Interoperability” is the term for sharing data across and between systems.  We have only begun to share data by this method. And yes—it has been slow.  Health care systems across the country have to have digital data in like formats before it can be shared.

Fact:  The recently released Final Rule for Stage 2 identified the Direct method of exchange for use in sharing records between providers and/patients.  This is –simply put—a secure e-mail type exchange that will allow documents, such as clinical summaries—to be shared between individuals—even patients.

Fact:  Private practice dietitians do not have to buy EHR software to exchange data with other providers and/or patients (although it would allow greater consistency in documentation).  They can subscribe to and use the Direct protocol mentioned above.

Fact:  The majority of those who have adopted health IT admit it was a challenge, we still have a ways to go but they would not return to paper records.

In closing, I am not entirely pleased with the requirements for “Stage 2” of the program the authors mention.  I have followed this legislation since it was passed in February 2009, have advocated for nutrition in writing and via public testimony almost 30 times yet still struggle to get nutrition data included in the regulations.  The two combined Stage 2 rules barely mention “nutrition” or “diet” in spite of the combined 1100+ pages and my 71 pages of comment supporting nutrition inclusion in both regulations (and in EHRs).  In spite of this roadblock, I believe in the adoption and use of health information technology in America via this legislation and can see the progress made over the past three years. 

I would challenge the authors to provide suggestions and champion areas where changes can save lives as well as money.  There has to be a “tipping point” where we work collaboratively to make positive changes and participate for safety and quality improvements in health care.  A good starting point is to take a look at food allergy inclusion along side of medication allergies in EHRs.  The potential effect on the patient is no less severe than medication allergies.  In short, I believe the glass IS half full, not half empty, and even with set-backs—believe that progress and eventual costs savings can occur.

Add a Comment
Comments (1):
9/19/2012 3:55:55 PM by Joan Medlen

I can't help but question this: "Fact: The U.S. is the last country in the world to adopt health IT, spends more than any other country on health care and has well known quality issues in spite of high expenditures." The last country in the entire world? Haiti has Health IT? Rawanda? Though I suspect we are last in countries that are similar to ours with regard to resources, and believe that E-records are a benefit to everyone (I like being able to access mine and my adult son's who has a disability), I am not convinced all third-world and developing countries are in this position. Are they? I'm happy to be wrong. And yes, I agree. The glass is half FULL. EHR have helped me coordinate care in a more expeditious manner than previously. Joan Guthrie Medlen, MEd, RD, LD

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