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| Herbert Pardes, M.D. | Carol Diamond, M.D. |
Ten months after Hurricane Katrina, reports critiquing the response to this disaster continue to be released. While there is much to learn from these assessments, the health care community also can find inspiration from some modest but innovative efforts occurring in the wake of the storm. One health information technology initiative points the way to improving care in future emergencies and everyday life.
Putting aside business interests and other agendas, a group of health technology companies, medical organizations, private foundations and government agencies collaborated to create a free, secure online service called KatrinaHealth (www.katrinahealth.org). This Web site enabled authorized physicians and pharmacists to access electronic prescription drug records of evacuees. Members of the KatrinaHealth working group made this critical information available because countless Gulf Coast residents’ medical records were washed away by floodwaters. These residents needed maintenance medications plus treatment for new conditions caused by the storm and subsequent evacuation.
In a matter of weeks, KatrinaHealth demonstrated how IT could improve health care for all Americans and why a nationwide system for securely locating and sharing electronic health records (EHRs) is so important. Medical, business and government leaders agree that such a system is needed to ensure that caregivers and patients have the health information they need, when they need it, to make good medical decisions. If a similar information infrastructure had been in place before the hurricane, health care for evacuees could have been delivered much more effectively and efficiently wherever they resettled.
Short-Term Solution
While the technology exists for widespread sharing of life-saving health information, the experience with KatrinaHealth revealed the barriers to adopting new technologies in our outdated health care system. First, privacy and security challenges persist. Second, persuading and enabling hospitals, health systems and clinicians to trade in their clipboards and pencils for 21st century information technology emerged as an uphill battle.
Privacy of personal information is a top concern of most Americans, and it has been heightened by numerous recent news accounts of breaches to financial and medical records. These reports have involved violations of data privacy at large financial institutions and small hospitals and health systems.
Health IT must be designed and used in a way that protects personal health information. The KatrinaHealth team ensured patients’ privacy by stripping certain sensitive information out of prescription records, establishing audit mechanisms to carefully monitor the network, avoiding the creation of a single central database, and limiting access to only those individuals who could be securely authorized.
But the ability to implement these privacy and security features was constrained by the solutions at hand. For example, access to evacuees’ medication histories was limited to physicians authorized by the American Medical Association. This meant that the many other health professionals seeing evacuee patients--not to mention the evacuees themselves--could not view the prescription histories. In addition, only chain pharmacies whose digital addresses could be verified over the network could participate in information sharing.
KatrinaHealth shows that we are far from resolving how to authorize and provide secure access to the many professionals and patients who stand to benefit most from a health information network. Further, it highlights the need for clear, 21st century policies so we can make good on our promises of data privacy and security to patients.
The health network revealed another obstacle: Most physicians do not expect to use IT as a routine part of providing care. In fact, much of their training is aimed at developing the interview skills necessary to extract as much information as possible from new patients when meeting and evaluating them. When we asked doctors in the field why only thousands--instead of tens of thousands--of physicians used KatrinaHealth, we were reminded that most clinicians are accustomed to seeing patients without a medication history available.
Call for Cooperation
To create the information-based health care system our nation so desperately needs, we must overcome these technological and human barriers to better health care. Let’s start by training a workforce that is ready to use health IT when caring for patients. At the same time, physicians, hospitals and health plans need to work together to speed IT adoption. Finally, we must earn the trust of Americans by ensuring their privacy even as we make their health information more readily available to authorized health providers.
As federal, state and local governments, private companies, and providers continue to modernize our health care system, we hope they will keep these lessons from Katrina in mind.
Herbert Pardes, M.D., is president and chief executive officer of NewYork-Presbyterian Hospital and Healthcare System and is a member of the board of the Markle Foundation. Carol Diamond, M.D., MPH, is managing director of the Markle Foundation and chair of Connecting for Health, New York.
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This article first appeared on June 21, 2006 in HHN's Magazine online site.
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