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
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
Author Comment: “Thousands of American physicians and hospitals that fail to buy and
install costly health IT…will face penalties through reduced Medicare and
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
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.
Dietitians are not included in this legislation (nor or any other
ancillary provider.) They will not receive any Medicare/Medicaid penalties or
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.”
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
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.
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.
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.
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.
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
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.
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.