March 2013 issue: It has general articles on (1) healthcare IT and economics (Payne et al.) ; (2) scope of informatics (Friedman); (3) impact of health IT certification and meaningful use; and research articles on (Vest et al.) (4) enhancing the robustness of cryptography for patient records; and (5) MEDLINE clinical queries; and (6) genetically guided personalized medicine.
(1) US spends (2005 numbers) on healthcare $6,041 per capita, twice the median $2,922 in 30 other industrialized countries; in 2008, it had risen to $7,681, thrice the 1990 estimate. Total for the nation: $2.3 trillion. Breakdown: 31% on hospital care, 21% on physician services, 10% on prescription drugs, 8% on nursing home care, and 30% on capital investment, admin costs, and other health related items. In terms of mortality, the US was 39th for infants, and 43rd for adult females, 42nd for adult males, and 36th for overall life expectancy. The HITECH (Health Information Technology for Economic and Clinical Health) act of 2009 will invest $30 billion in health IT. Incentives to eligible providers and organizations for adopting electronic health records (EHRs) will get the bulk of it. The legislation wants all to use certified EHRs, facilitate clinical data exchange, and report quality metrics. ‘Meaningful use’ is needed to qualify for the incentives. Health IT can improve healthcare and control costs in the following ways, as per reports from the National Academy of Sciences: provide detailed information about healthcare; reduce cost in the care of individual patients; and support changes in healthcare delivery. Evidence needed to validate the investment: The authors used keywords from a 2003 paper by Wang and colleagues on cost-benefit analysis to identify later studies (15). For example, using a threshold of $50,000 per quality-adjusted life year (QALY), health IT is cost effective based exclusively on preventive care. But this conclusion was not always reached when other perspectives were considered. There may have been confounding factors; so, there is need to rigorously evaluate efficacy, effectiveness, and safety of health IT. Defining the worth of health IT: UK’s National Institute for Health and Clinical Excellence establishes both policy and evaluates and extends the evidence base to determine its worth. Pioneers in US Health IT: Kaiser Permanente implemented EHR to transform care ans service delivery by focusing on quality outcomes, patient satisfaction and engagement, unneeded services and inefficient processes, and population management. Geisinger, Partners HealthCare, and the VA hospitals are other examples. These entities use health IT not to automate paper processes but to leverage transformative changes in the delivery of care.
(2) The term is currently ill defined. There is confusion between health information management and health informatics. The Council on Accreditation for Health Informatics and Information Management (CAHIIM) used to be CAHIM, with the “I” for information management. Proliferation of undergraduate programs in health ‘informatics’ that enrolls a diverse group of students is a cause for concern. This paper uses three perspectives to better define the field: (a) Health IT as cross-training, where a set of relevant basic sciences meet an application domain that is typically a field of professional practice. The basic sciences include at a minimum information science, computer science, cognitive science and organizational science. Cross-training between these sciences and the domain of medicine gives ‘medical informatics.’ Collaboration between basic scientists and full-time professionals is implied. (b) Effectiveness of health care – ‘the fundamental theorem’ – that persons supported by IT will be better thatn the same person performing the same task unassisted. (c) The ‘Tower of Achievement’ – frames informatics as a four successive step sequence: model formulation, system development, system deployment, and study of effects.
(3) Health information technology (HIT) certification on the supplier side (to help EHR buyers to make informed decisions oh Health IT purchases) and meaningful use, articulated in the 2009 HITECH act, constitute a $27 billion federal intervention to encourage EHR adoption. This is envisioned to transform the marketplace. This paper documents quantitatively the demand and supply sides of the EHR market. Hospitals were categorized into small (<100 beds), medium (100-249 beds), and large (>249 beds). They used Dartmouth Atlas’ Hospital Referral regions (HRRs) to define the local geographic EHR market. HHRs divide the country into distinct regions based on hospitals’ performance of major cardiovascular and neurological procedures. EHR vendor competition was measured with the Herfindahl-Hirschman Index (HHI), which is the sum of each vendor’s market share squared. Increasing HHI indicates EHR market concentration, whereas decreasing HHI implies healthier EHR competition. The authors found that overall there was movement away from paper records, towards more EHR vendors, and more competition. Changes were greatest in small hospitals; for large hospitals, competition and the number of vendors did not change. The EHR market is thus changing most dramatically for those least equipped to handle the broad technology transformation; continued targeted support is needed.