To qualify for a piece of the $19 billion being offered through the American Recovery and Reinvestment Act (ARRA), healthcare facilities will have to justify the significance of their IT investments to ensure they are "meaningful users" of EHRs. The Department of Health and Human Services has yet to define what it considers meaningful use (this is on the HHS agenda for December).
Aggregating info to create knowledge
Ideally, in addition to providing doctors with basic information about their patients, databases of vital signs, images, laboratory values, medications, diseases, interventions, and patient demographic information could be mined for new knowledge, D'Avolio says. "With just a few of these databases networked together, the power to improve health care increases exponentially," D'Avolio suggested in the September 9 issue of the Journal of the American Medical Association (JAMA). "All that is missing is the collective realization that better health care requires access to better information—not automation of the status quo." Down the road, the addition of genomic information, environmental factors and family history to these databases will enable clinicians to begin to realize the potential of personalized medicine, he added.
"Much of the information contained in electronic records is formatted as unstructured free text—useful for the essential individual communication but unsuitable for detecting quantifiable trends," such as outbreaks of infections, D'Avolio wrote in JAMA.
Data analysis experiments performed by Ben Shneiderman, a University of Maryland computer science professor and founder of the school's Human-Computer Interaction Laboratory (HCIL), and his colleagues indicate what the future holds if EHR systems are improved and implemented. "If there's enough information available, and it's able to be searched effectively, a doctor could essentially be running a virtual clinical trial for each patient by studying existing patient data," he says. "The real power of [EHRs] comes not from looking at just one patient but rather being able to analyze similar information across millions of people."
And although there is criticism that electronic medical records today are little more than digitized versions of paper forms, National Institute of Standards and Technology (NIST) Director Patrick Gallagher is optimistic that the ARRA money, combined with the $80 million in grants HHS is offering to train health IT workers, will push EHR adoption in the right direction. "The way I've been thinking about it, it simply would not have risen to the level of priority it has if it was simply about digitizing records in a doctor's office," says Gallagher, who took over as NIST director in early November. "I don't think we'd be investing as much as we're investing. This is about using technology to bring health care information together to reduce medical error, reduce the need for testing, put information in front of patients, and put information in front of researchers."