Thursday, May 10, 2007

Quality Assurance, Standards, Interoperability

By coincidence Steve Beller, PhD in his recent blog on trusted.md posted some information relevant to health information transparency, and health information exchange. The RHIO monitor has attempted to keep interested readers somewhat current with these developments in the past two years. Readers may go to http://healthtrain.blogspot.com to read more about RHIO attempts in Southern California and elsewhere.
A group of standards for interoperability have been established for electronic medical records by the CCHIT (Commission for Certification of Health Information Technology. These vendors can be found at CCHIT's web site, and also at CALRHIO www.calrhio.org These are standards for electronic interoperability and functionality of an EMR. They however do not standardize nomenclature for diagnosis and procedures, nor pay for performance metrics. There are diagnostic standards, (ICD codes) and procedure codes (CPT codes) that are used by medicare for data mining, however these statistical figures are derived from financial data and not true clinical information.
Due to HIPAA regulations true transparency will never exist, to prevent violation of privacy rules. Statistics will be stripped of patient identifying information.
Organizational strategies are ubiquitous and range from non profit collaboratives, private foundations, community clinics, and now some entrepeneurial asp models for EMR and RHIO portals. One barrier has been a "sustainable business model."
A significant number of RHIOs have failed, the most recent in Santa Barbara after ten years of attempting to overcome barriers of self interest, mistrust and loss of public funding grants for startups.
The situation is highly complex and cannot be oversimplified. While many proponents liken the banking industry and it's information structure to health care IT, they are radically diffferent, and not as simple as inserting an atm card into a terminal...While banks have developed highly secure systems, additon and subtraction of simple numbers is not the same as a medical record system, much of which is analog in nature rather than digital.

More about these efforts in my next post. Steve is on the right track and his comments are all on the mark. Most physicians are so busy with medical care the don't have time to be proponents of HIE, although if given a cost effective system that is non disruptive they would readily accept it. The devil (as always) is in the "details".
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