Get Ready For e-Medicine

From the August 9 issue of Newsweek:

When Anne Perlman, 50, needs to see her doctor at the Palo Alto Medical Foundation (PAMF) in California, she schedules her appointment online. Prescriptions zip through the ether from her physician to her pharmacy. Test results go into her electronic medical records. (Once she even got a lab test back on a Sunday—”very cool,” she says.) And Perlman can log on any time to take stock of her health: Did her cholesterol go down this year? When was her last tetanus shot? For Perlman, the business of medicine is … get this … “a pleasurable experience.”

If you’re one of the millions of Americans still in the medical dark ages, take heart: e-medicine may be coming your way soon. In July, the government launched a bold plan to get doctors and patients wired over the next 10 years. To encourage participation, officials are looking for ways to reduce costs and ensure software compatibility nationwide. The goal: a vast electronic network, where records can be securely viewed by any doctor or ER you visit. There’s more at stake than convenience. Electronic medical records could save $140 billion annually and slash medical errors, which contribute to tens of thousands of deaths a year. “It’s the right thing to do, it’s the right time,” says Health and Human Services Secretary Tommy Thompson. “We have to transform the practice of medicine.”

Paperless medicine means you’ll be able to go from your GP to your cardiologist—or to a new doc-tor in another state—without having to cart around old records. Your physician, privy to your complete history, will no longer need to rely on you for medical details; you may just walk away with a more accurate diagnosis. Computers will send reminders about vaccines or alerts about dangerous drug interactions. Electronic prescriptions will reduce errors caused by bad handwriting. And for non-urgent matters, you and your doctor will be able to communicate through a secure messaging system, saving time and a lot of frustration.

Electronic medicine won’t happen overnight, but you can start managing your health today. Begin by asking your doctors for a copy of your medical records. Web sites like WebMD offer programs where you can store and organize information (healthmanager.webmd.com). And electronic gizmos, such as Med-InfoChip, allow you to download your medical profile onto a computerized key chain (med-infochip.com). But keep in mind that federal law, which protects the privacy of electronic records in doctors’ offices and hospitals, doesn’t apply to private companies. Read online policies carefully: the company could share your personal health information with a third party. Even if a site looks secure, buyer beware: “A commercial dot-com can promise you privacy, but what if somebody buys it or it goes bankrupt?” says Dr. Paul Tang, who launched PAMF’s electronic system. “Your privacy is more protected by your physician.”

The buzz around the National Healthcare Information Infrastructure is starting to feel like the buzz around the National Information Infrastructure initiatives from ten years ago…

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Tagging Pharmaceuticals

Ross Stapleton-Gray writes:

Project Jumpstart, discussed in this article, is an effort by major pharmaceutical manufacturers to test item-level RFID tagging of drugs as an anti-counterfeiting/theft strategy.

In considering the surveillance issues, drugs are certainly a sensitive issue; on the other hand, it would be easy to “shed” the tags, as an end consumer. My question would be more toward the claims for anti-counterfeiting. Given that the means of detecting counterfeits won’t be through detecting a counterfeit tag — tags are easily copied — but in assessing the object’s claimed pedigree, it just seems too complex to work all that well. Any number of insiders could probably compromise such schemes fairly easily, for example; until and unless RFID reading throughout supply chains becomes highly pervasive, a great many products will sport pretty sparse pedigrees as it is.

A stat from the above Information Week article: “The pharmaceutical industry estimates that between 2% and 7% of all drugs sold globally are counterfeit. Earlier this year the Food and Drug Administration issued a report recommending that drugmakers use RFID on bottles of the most commonly counterfeited drugs starting in 2006 and on bottles of most drugs by 2007.”

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Your Medical History On A Microchip

Laura Landro’s Informed Patient article in the Wall Street Journal on July 27, 2004:

The idea is to put together records that patients control and manage
themselves, collecting data from different providers and sharing it as
they see fit. Consumers surveyed by the group Connecting for Health
became receptive to the idea of electronic medical records after
viewing an ad showing a man falling from a ladder with the caption
“You have three seconds to remember every doctor you’ve ever seen,
every procedure you’ve ever undergone and every medicine you’ve ever
taken.” In addition to recording vital information such as next-of-kin
contacts and lists of allergies, patients could use the records to
track their own immunizations and note any mistakes in their doctor’s
records.

Step by step the National Health Information Infrastructure will get built.

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The Decade of Health Information Technology

Last week U.S. Health and Human Services Secretary Tommy Thompson released the first outline of a 10-year plan to build a National Electronic Health Information Infrastructure in the United States.

The report, “The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care,” lays out the broad steps needed to achieve always-current, always-available electronic health records (EHR) for Americans. This responds to the call by President Bush this year to achieve Electronic Health Records (EHRs) for most Americans within a decade.

See also: Conference Materials for National Healthcare Information Infrastructure 2004, last week’s summit on the subject.

Secretary Thompson announced a range of actions underway or soon to be launched, which will advance the strategic elements of the Framework:

Establishing a Health Information Technology Leadership Panel to evaluate the urgency of investments and recommend immediate actions — Secretary Thompson will appoint the panel of executives and leaders to assess the costs and benefits of health information technology to industry and society, and develop options for immediate steps by both the public and private sector, based on their individual business experience. The Health Information Technology Leadership Panel will deliver a report on these options to the Secretary no later than fall 2004.

Private sector certification of health information technology
products — EHRs and even specific components such as decision
support software are unique among clinical tools in that they do
not need to meet minimal standards to be used to deliver
care. To increase uptake of EHRs and reduce the risk of
product implementation failure, the federal government is exploring
ways to work with the private sector to develop minimal product
standards for EHR functionality, interoperability, and
security. A private sector ambulatory EHR certification task
force is determining the feasibility of certification of EHR
products based on functionality, security, and
interoperability.

Funding community health information exchange demonstrations
— HHS’ Health Resources and Services Administration, with
the Foundation for eHealth Initiative, announced $2.3 million in
contracts to support the Connecting Communities for Better Health
Program. The program is providing seed funds to implement
health information exchanges, including the formation of regional
health information organizations.

Planning the formation of a private interoperability
consortium — To begin the process of movement toward a
national health information network, HHS will issue a Request for
Information (RFI) this summer inviting responses describing the
requirements for private sector consortia that would form to plan,
develop, and operate a health information network. The role
that HHS could play in facilitating the work of the consortium and
assisting in identifying the services that the consortium would
provide will be explored, including the standards to which the
health information network would adhere in order to ensure that
public policy goals are executed and that rapid adoption of
interoperable EHRs is advanced.

Requiring standards to facilitate electronic prescribing —
CMS is accelerating publication of a regulation laying out the
first set of widely adopted e-prescribing standards in preparation
for the implementation of the new Medicare drug benefit in 2006.
When the final standards are adopted, Medicare Prescription Drug
Plan (PDP) Sponsors will be required to offer e-prescribing, which
will significantly drive adoption across the United States.
The proposed regulation will be published by CMS this year.

Establishing a Medicare beneficiary portal — CMS will
develop a Medicare Beneficiary Portal, an immediate step in
improving consumer access to personal and customized health
information, providing secure health information via the
Internet. The portal will enable authorized beneficiaries to
have access to their Medicare information online or by calling
1-800-MEDICARE. Initially the portal will provide access to
fee-for-service claims information, which includes claims type,
dates of service, and procedures. The pilot test for the
portal will be conducted in Indiana, beginning this year. In
the near term, CMS plans to expand the portal to include prevention
information in the form of reminders to beneficiaries to schedule
their Medicare-covered preventive health care services. CMS
also plans to work toward providing additional electronic health
information tools to beneficiaries for their use in improving their
health.

Commitment to standards — A key component of progress in
interoperable health information is the development of
interoperability standards and policies. HHS, DoD, and VA
have endorsed 20 sets of standards to make it easier for
information to be shared across agencies and to serve as a model
for the private sector. Additionally, the Public Health Information
Network (PHIN) and the National Electronic Disease Surveillance
System (NEDSS), under the leadership of the Centers for Disease
Control and Prevention (CDC), have made progress in development of
shared data models, data standards, and controlled vocabularies for
electronic laboratory reporting and health information
exchange. With HHS support, Health Level 7 (HL7) has also
created a functional model and standards for the EHR.

This announcement of a National Healthcare Information Infrastructure brings back memories of the push a decade ago for a National Information Infrastructure (which led to vast investments in building up the public Internet).

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