At the Office of the National Coordinator for Health IT’s HIT Policy Committee Certification and Adoption Workgroup meeting July 14, there was the usual bantering and expectations about meaningful use. But above the cacophony, I heard something not usually spoken. And it came from someone who ought to know.
William Stead, MD, is the associate vice chancellor for Strategy and Transformation and the director of the Informatics Center at Vanderbilt University in Nashville. He is also the medical center’s chief information officer and the university’s chief information architect.
He calmly and assuredly told the workgroup this: Beware of setting things in stone.
In a January report for the National Research Council, Stead argued that efforts aimed at the nationwide deployment of health IT will not be sufficient to achieve medical leaders’ vision of healthcare in the 21st Century and may even set back the cause.
The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of healthcare IT, concludes that greater emphasis should be placed on IT that provides healthcare workers and patients with cognitive support, such as assistance in decision-making and problem-solving.
The study found that although the institutions showed a strong commitment to delivering quality healthcare, their IT systems fell short, suffering from difficulties with data sharing and integration, deployment of new IT capabilities, and large-scale data management. Many care providers interviewed for the study said data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care.
In the short term, lawmakers should avoid programs that focus on adoption of specific clinical applications, the report said.
“Change is not possible if we are simply driven by the tool,” Stead said.
Stead said lawmakers should provide incentives for IT adoption that will build a fluid system to allow for the drastic changes in available data to come. He used the example of diabetes: in the 1970s, there were two types. Now there are four. Soon, with genetic information, there will be 20 or more. “Data needs to be redefined as something that can be correctly interpreted in the light of today’s knowledge,” he said.
“If we narrowly limit our use of standard data—that data that can have only one interpretation over time,” he added. “If we keep the raw data, we can re-run it later.”
When it comes to certification, less is more, Stead said. Certification today is based largely on what the best of today’s systems can do. We need to start with what is the essential ingredient that will allow this to work over time. Liquidity.
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