Posted by cadsmith on September 6, 2009
Doctors have discovered a cure for illegible handwriting. All medical data is becoming digital. Real-time patient data is included in hospitals. Patients own the data. It can be accessed anywhere/anytime by logging onto a portal.
Besides security, there are issues analogous to celebrity athletes encouraged to undergo strictly private tests only to have their results published in the press. Patient commentary outlets are yet to be defined.
The US government has earmarked at least a couple of billion dollars for IT infrastructure to spread across clinics. Broadband allows online access at the highest possible bandwidths. An electronic medical record (EMR) is generated by a treatment organization. An electronic health record (EHR) is the set of EMRs from all places. Advantages are compliance, efficiency, access, reporting, coding, and quality. These are required to support meaningful use features including computerized order entry, drug interaction checking, maintaining an updated problem list, and generation of transmissible prescriptions. Interoperability of Health Information Exchange (HIE) is a major theme. The criteria are expected to become more complex in 2013.
The new gear changes procedures and vice-versa. Not as many filing clerks are needed. Templates and quality reports are broadly well-defined. Database use schema, or at least have formats to allow vendors to translate to eachother. Redundant tests are less necessary since a patient’s complete history and status are known. Loss of data is an issue. Records need to be kept for 7 to 21 years depending upon local regulations so previous paperwork is still saved. Thorough consistent quality checks are essential. Medical device testing is rigorous, e.g. FDA clinical trials, so medical data is expected to have regulatory monitoring. Open data standards are required.
Early adopters have already started to avoid an expected EMR backlog. The transition is gradual since this new type of productivity effort needs acclimation. It requires a project plan to complete, and ongoing management in addition to tech support. New patients are easier to add since previous hardcopy records do not need to be input. Insurance providers, Medicare and Medicaid offer incentives by rewarding 44k or more after successful implementation to lower insurance premiums. Financing loans are available. Preliminary certification begins in October. 20% of transition attempts have been unsuccessful due to a variety of causes such as functional, technical, integration, incompatibility, usability, dysfunctional, or expense. Transition times are expected to be reduced as procedures are debugged. Clinics which grow in size may need to change EMR providers.
The data types are familiar, e.g. accepted standards such as HL7, XML and export to PDF. Imaging devices generate more graphics, e.g. CT and MRI. Record storage is networked, locally and on the internet. Snapshots are kept on USB, smartcard, bracelet and, in some cases, implant. Realtime data is significant in the ER and OR and streamed from patient monitors elsewhere, e.g. wirelessly transmitting vitals using 802.11. Drawing conclusions from the database may require filling in blanks or adding more resolution.
Private clinics are growing in number. Hospital IT is simultaneously adding more sophisticated management and research systems, e.g. Microsoft Amalga. EMR implementations are going on internationally, e.g. Taiwan. Pervasive medical surveillance is part of larger efforts. The world’s biggest democracy, India, is requiring national ID cards.
Also see wiki topic.
Image: Structural MRI