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Great post. It’s great to see bloggers comment on the published political perspective about health care as we approach next week’s election. While it is only one of many social and economic components that weigh into this election, health care - without a doubt - is an important and complex one. It is an issue that spans all races, religions and social boundaries.

Here at Public Agenda we’ve put together an informative, non-partisan guide that focuses on the facts and on the plethora of perspectives surrounding the health care debate in America. Be sure to check it out at http://publicagenda.org/citizen/electionguides/healthcare and feel free to contact us with any questions.

On of the biggest issues that impacts the entire industry is the challenges in defing and adopting true interoperability data standards. Their is tremendous resistance related to impacts on “proprietary positions” and “creativity” let alone the inertia of change for existing systems. To address some of these concerns in lectures that I have given I use the music analogy. At some time in the past a defined set of standards at a very precise level was established and adopted for music notation. This standard do not try to force anyone into using a specific instrument, language or style of music, but was very precise about about notes, timing, scales and other canonical functions. Because of this we can pick up any instrument and play music written by someone that wrote it hundreds of years ago in a foreign country. We can play it with others that we have never met using a wide variety of instruments. We can use the same standard for jazz, rock, classical, country or any other varieties of music.

To date this standard has enabled and enhanced both prorietary efforts and creative and has definitely enhanced the world experience. Until we can get to that interoperability standard we will have a real problem playing great healthcare music together in an envronment that support creativity and proprietary interests.

Please see Dr. Simborg’s blogs. The problem is that Dr. Halamka and many others act as if Health IT has a value proposition that can be beneficial NOW. Currently EHRs remain unregulated, non-standardized, and Certified against very low qualifications. For example, current certification requirements allow a system to obliterate the original version of an amended health care record, a practice that even the most junior clinician knows would impeach the integrity of a medical record.

Until these systems are sufficiently standardized to support fundamental requirements of trustworthy medical records, they are not suitable for secondary uses of health care data and may endanger their primary use-patient care.

The nice thing about baseball statistics is that they are highly standardized. Those are easy to computerize. Until there is a standard requirement set for a valid medical record on a computer, any national initiative to accelerate EHR implementation is ignoring risk which, by and large, has not worked out well as national policy.

The good news is that there are well-designed systems out there that, when used properly, can create, manage, and preserve a trustworthy electronic medical record. However, few if any buyers have that on their RFPs and fewer actually test systems prior to purchase for their ability to even support their practice or their hospitals current requirements for valid records. Until the market defines and demands integrity in EHRs, all uptake is built on irrational exuberance for future promises that cannot be kept with today’s average EHR. (You have to ask, you have to test to be sure.)

RDGelzer
Advocates for Documentation Integrity and Compliance

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