Health care record needs cited at an IBM conference

Computerization of health care record keeping remains both a need and a challenge, said IT and health care dignitaries at an IBM-sponsored conference in San Jose, Calif. on Monday.

IBM’s New Paradigms for Using Computers 2007 workshop focused on health care interfaces. Previous years’ workshops have covered such topics as Web 2.0 and mobile computing.

“Health care is moving in the direction of computerization, but there’s so many difficult issues in the user interface in particular that have not been addressed,” said John Barton, manager of Interaction Science at IBM.

Right now, health care is plagued by bad interfaces, said Paul Tang, vice president and chief medical officer at the Palo Alto Medical Foundation in Palo Alto, Calif.

“It’s really driving under the influence of terrible interfaces,” he said.

Tang cited studies that estimated 44,000 to 98,000 deaths per year in the United States resulting from medical mismanagement in hospitals. Patient safety would be enhanced by having better information available, he stressed. Information is fragmented. “There’s almost no way a single individual could put this stuff together,” but health depends on it, he said.

Rather than just throwing computers at what are now paper processes, ethnography would help in figuring out what information is needed, said Tang. 

At Palo Alto Medical Foundation, a Web site, PAMFOnline, provides patients and health care persons access to the same records. Patients can enter information and access data like test results. But patients can only add to personal, not official, health records, Tang said.

About 45 percent of the foundation’s patients are signed up. Should they choose, patients can pay $60 year to send messages to their doctors via the site, said Tang.

He said he did not expect to ever see a centralized national health record database because of public concerns over privacy and security. “To put all information into one database just puts too much at risk,” Tang said when interviewed after his presentation.

Introduction of electronic health records is a nice way to make doctors and nurses more efficient, but it takes more time to use a computer than paper, said speaker Jakob Bardram, a professor at the IT University of Copenhagen who has been involved in health care. Paper records will not go away, he said.

It is easier, however, to retrieve information on computers than on paper, Bardram said.

Hospital persons need to be able to move about the building and enter information on different systems rather than being consigned to a single terminal for data entry, he said. PDAs, for their part, are not much of a solution because they do not have batteries that will have last a full seven-hour shift, said Bardram.

“I think [PDAs] have a hard time in hospitals,” Bardram said. But PDAs are being used in hospitals, he said.

He urged development of middleware or operating systems that support mobility in hospitals and extend to health care workers’ homes.

Through a concept dubbed “Activity Roaming,” health care workers could move between different computers and systems. A middleware platform has been developed for this, but it has not been deployed yet, said Bardram.

IBM efforts in health care have included work on standards such as HL7 (Health Level 7) as well as participation in the Nationwide Health Information Network. The company is seeking to connect islands of information, such as patients, clinics, and hospitals.

Also the event, Barbara Bennett, a health care business and transactional lawyer, said the IT industry has no clue what it means to delve into health care because health care is heavily regulated and IT has had little of this

“It’s overwhelming” to people used to a business has been essentially unregulated, Bennett said.

She listed key legal risks to watch for in developing products for health care:

* Privacy and security, including overlapping federal and state laws.

* FDA regulations that govern how medical devices, including software, can packaged, labeled, marketed, and sold.

* Medicare reimbursement, in which products must be reimbursable if they are to be sold.

* Fraud and abuse, in which influencing patient or physician choices can be seen as an attempt to steer health care product referrals. This factor can affect a product design and sales strategy.

* Malpractice. Technology can be seen by users as potentially causing mistakes rather than preventing them.