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A Major Milestone on the Path to Health Care Information Technology?

By John Reichard, CQ HealthBeat Editor

October 31, 2006 -- Saying it has reached a major milestone in the effort to harness the vaunted power of health information technology, a public–private advisory group announced an agreement Tuesday on standards for maintaining personal health data, transmitting clinical lab results, and managing disease outbreaks.

"Standards" are the key to realizing the potential of health IT to make a variety of medical data widely and easily accessible, easy to use, and understandable and to prompt physicians to use up-to-date treatments that provide superior care.

Agreeing on standards will allow doctors around the country to speedily access a patient's medical history, thereby avoiding faulty diagnoses and the expense of ordering duplicative tests. It will keep doctors from prescribing the wrong drugs and dosages, remind them to order preventive care and help them adhere to the most up-to-date guidelines for treating a wide variety of diseases.

It will allow proliferating medical information systems to "talk" to each other so data can be widely and easily shared—and so that hospitals and doctors will be willing to invest in them.

The standards accepted on Tuesday by the advisory group—known as the American Health Information Community (AHIC) —deal with only a slice of health IT's uses. However, their development established a process that will speed agreement on health IT standards in a wide variety of other areas, said John Halamka, chairman of the panel that forwarded the lab, personal data, and biosurveillance standards to AHIC.

AHIC's formal action on the standards Tuesday was to agree that they should be forwarded to the Department of Health and Human Services for consideration. President Bush issued an executive order in August that will require providers doing business with Medicare and other federal health programs to have health IT systems that meet such interoperability standards.

The standards mark "a small step in the total number of standards that need to be considered, but a very large step . . . in movement toward interoperability," said John Loonsk of the Office of the National Coordinator for Health Information Technology at an AHIC meeting on Tuesday.

Agreement on the standards represents "the essence of what the community is here to do," said its vice chairman, Dr. David Brailer. It "represents an enormous amount of work." Added AHIC Chairman and HHS Secretary Michael O. Leavitt, "I don't have words to tell you how profoundly important this is."

The effort to identify standards for clinical lab results transmission, maintaining personal health data, and conducting biosurveillance was carried out for AHIC by another public–private group, the Health Information Technology Standards Panel (HITSP), chaired by Halamka.

The panel identified some 30 standards it said should be used in the three areas after reviewing 700 possible standards developed by 261 organizations. Volunteers worked a total of 12,000 hours in assisting the effort.

The standards agreed to for reporting clinical laboratory data will make it easier to understand those results and thereby avoid duplicative and unnecessary testing, HITSP said. The standards also will make it easier to add lab results to electronic health records designed to record the entire medical history of a patient.

Other standards agreed to apply to "personal health records," which are under a patient's control and include only a subset of the data in an electronic health record. Personal health records are in part designed to make it unnecessary to fill out the clipboard of forms patients often encounter with each new visit to a doctor's office.

"Going to the doctor or hospital frequently requires filling out multiple forms," HITSP noted in a report forwarding the recommendations. "These forms collect information such as name, address, insurance, medications, allergies, etc. Then, when an individual requires laboratory work or other testing, the same information has to be collected again. A single electronic registration will make it easier for individuals to give their information and for clinicians to use it."

The standards also should ease inclusion in the personal health record of an up-to-date history of a patient's medication use. Most patients "do not know the specific medications and the exact dosages that have been prescribed to them, and often do not know their allergies," HITSP noted.

"In addition, clinicians do not always have consistent prescription information about the same individual nor do they have easy access to medication information directly from the patients. Too often, this results in errors or unnecessary treatments."

The biosurveillance standards are designed to foster use of systems to quickly detect and monitor disease outbreaks and to rapidly respond to them. They are intended to ease rapid transmission of disease data from emergency departments, doctors' offices, and clinics to public health departments.

AHIC also heard Tuesday from speakers who discussed how health IT could be used to disseminate advances in diagnostic testing and treatment based on the explosion in knowledge about "genomics"—the role of genes in triggering disease.

Electronic health records could be the pathway for introducing such medical advances, said Gregory Downing of the National Institutes of Health. Gene-based tests would enable predictions of the risk of developing a disease and develop genetic profiles that could be used to ensure that only highly effective treatments are used, he said.

But Alfred Berg of the University of Washington School of Medicine noted that primary care doctors, who would be a key force for incorporating the use of such tests in medical practice, are "relentlessly empirical."

Prompts to doctors in electronic health records to use such tests would have to be based on evidence that they improve clinical outcomes compared with current tests, he said. But clinical data linking the tests to better outcomes is lacking, he said. "The quantity and quality of information has been disappointing," Berg said. Although genetic testing holds "great promise," Berg said, "there will likely be few examples of genetic tests that meet standards for common use in typical practices in the next three to five years."

But other speakers emphasized that understanding a patient's genetic makeup is key to safe and sound diagnosis and treatment and that genetic testing is already a part of medical practice today. At Leavitt's prodding, AHIC agreed to form a work group to review standards in this area that would foster the inclusion of gene-related data in electronic medical records.

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