Zakaria and Meyerson: How to Fix Health IT

By Sammy Zakaria and David A. Meyerson
Thursday, September 17, 2009; 7:22 PM

President Obama's address to Congress on health-care reform overlooked one of the most important issues: the poor state of health information technology.

Last week, a 62 year old woman, whom we will call Mrs. B, came into our office complaining of shortness of breath. She also mentioned a history of severe hypertension, coronary artery disease and dialysis-dependent kidney failure. We discovered that she had been admitted several times in the past year to five different area hospitals. Beyond these bare facts, we had no other information. We had no reliable details of her recent testing, treatment or medications. Also, she could not recall the names or dosages of her sixteen pills, and she knew that she was severely allergic to a certain heart medicine, but she couldn't remember its name, either. We were understandably reluctant to prescribe new medications or therapies without obtaining her recent records.

Mrs. B's situation is all too common. Information is fragmented and not readily accessible. Even the most prepared patient carrying copies of previous medical records is handicapped by the difficulty in deciphering handwriting and medical notations. It is common for duplicate tests to be ordered, increasing health-care costs by perhaps 15 percent or more.

Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities. The stimulus bill included $50 billion dollars to promote uniform electronic record standards, but it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software.

A cheaper and more effective solution is to adopt a standard electronic record-keeping system and ask that all health information software interface with it. In fact, a proven system already exists. The software is called the Veterans Health Information Systems and Technology Architecture (VistA), which the Veterans Affairs Department developed. VistA requires minimal support, is absolutely free to anyone who requests it, is much more user-friendly than its counterparts, and many doctors are already familiar with it.

Numerous scientific studies have concluded that using the system leads to fewer medication and allergy errors, increased utilization of cost-effective preventive-care measures, and decreased duplicate testing. In fact, VistA has been so successful that it is now used by numerous organizations, states and 13 countries worldwide.

If VistA had been available in our office, Mrs. B could have mentioned her previous treatment providers and given her express permission to access the records. We would have contacted her previous institutions electronically and obtained a complete medical background within seconds, rather than spending several hours questioning her and calling her previous providers.

The writers are cardiologists at Johns Hopkins Medical Institutions.

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