Besides better management of health data, College offers federal officials ideas on how to make the system less of a burden on physicians
Feb. 8, 2019 (ACP) – Health information technology has made it into nearly all non-federal acute care hospitals in the United States and more than three-quarters of physician offices. While these numbers represent significant progress, the American College of Physicians has reminded policymakers that much more work needs to be done to make sure technology doesn't make everyone's lives more difficult.
“Physicians agree that sharing data is a good thing in theory, but in the practical world, just sharing for the sake of sharing data is not really helpful,” said Dr. Patricia Hale, a Saratoga Springs, N.Y., internist who chairs the American College of Physicians' Medical Informatics Committee. “Problems involving data are a huge concern, and they're really impeding the care of our complex patients.”
However, ACP is stepping up its advocacy in this area. The College recently sent a 16-page letter to the federal Office of the National Coordinator for Health Information Technology in response to a draft report about how to reduce regulatory and administrative burdens linked to health IT and electronic health records.
ACP's message is clear: Interoperability and better management of health data are hugely important, but the current system has major flaws that place inappropriate burdens on physicians.
The government has used incentives to prod physicians into sharing more data, Hale said, and this is creating a kind of information overload.
“As a physician, you have to sift through this big mess of data to find useful clinical information,” she said. “Some of it is relevant to the patient, and a whole bunch of it is not. People are even sent back the same data that they sent out.”
It's especially challenging when patients have multiple physicians, she said.
“You could have eight different doctors seeing a patient who's been in and out of rehab centers or nursing homes, and all of them are sending data to each other.” Hale said. “There's no way to reconcile what's old with what's new and current.”
She recalls seeing a patient at an academic medical center who'd come back after a stay at a long-term care center. Judging from medical records, the patient appeared to have 32 different medical diagnoses – but in fact, “that really wasn't the situation,” Hale said. “Information was added on every time the patient went anywhere, and the system didn't know how to separate it. Also, the patient's stroke was described in five different ways because people had put in different descriptions.”
The problem extends to medications, too, as they can be listed over and over. “You can have the same medication listed two or three times, each time slightly differently,” she said.
ACP is making it clear that simply providing more data doesn't translate to better outcomes.
“We need to look at this from the clinical view of what's important as that patient transfers from one facility to another,” she said. “How do you get it there in a usable format?”
Simple actions should be easier, too, such as updating a medication list to take account of a cancelled drug.
“People think we've got e-prescribing, we have all these tools, and it's all done so we can do more fancy things,” Hale said. “The truth of the matter is we haven't straightened it out and gotten the important simple stuff right.”
Moving forward, Hale and others from ACP are working with Dr. Don Rucker, the national coordinator for Health Information Technology.
“Dr. Rucker and several members of his staff are internal medicine physicians,” Hale said. “They've met with different members of ACP, and it's been a joy to work with them. They're extremely knowledgeable about the issues, and they're very open to listening. We know that letter we've sent will absolutely be considered.”
Meanwhile, ACP plans to continue pressing its message that data must be clinically relevant to patient care, as well as an additional message: That physicians must be compensated appropriately for managing complex patient care.
“The federal shutdown has thrown off the timetable for decisions at the federal level,” Hale said. “But we're in this for the long haul, and we will continue to make sure our voices are heard.”
ACP's letter to the federal Office of the National Coordinator for Health Information Technology is available on the College's website.