I have a good friend at Duke University
– Dr. Ed Hammond. (Ed has been involved in advancing electronic
health information for quite some time – probably longer than he'd like
to remember.) Ed once told me that to get a perspective on how
long we – (our nation) has been assessing the potential of automating
health information you'd have to go back to the introduction of Medicare
in 1965 when President Johnson signed the legislation and officially
enrolled Harry Truman as the first Medicare beneficiary.
A provision of that legislation commissioned
the first study to evaluate the impact on the cost and quality of healthcare
relative to this emerging capability loosely referred to as “information
technology”. I believe we can all readily admit that much has
changed since 1965, (even if we weren't around in 1965, or aware in
1965.) For years the debate focused on standards, architecture,
common language, who/how do we pay for this automation, etc – many of
these debates certainly continue today.
The most recent addition to this dialogue
focuses on “meaningful use”. I saw a press release out of
HHS last week announcing “Process begins to Define Meaningful Use
of Electronic Health Records”. Now I have to preface my
comments by saying – I am an unwavering advocate of electronic health
information – a strong believer in the value for the individual health
consumer, as well as the greater good of managing health information
across populations. There can be no doubt of the benefits of efficiently
managing health information with all of the benefits of our ever increasing
powers of information technology. We can look virtually anywhere
in our lives, our economy to see the impact and benefit.
Now as we enter a period of public
comment on meaningful use – I'm struck by the irony of the very concept.
Imagine a time long ago when the telephone was first invented.
Prior to gaining land rights to string phone lines hearings had been
held on “meaningful use” of the telephone. The debate likely
would have proceeded for years – “who are you going to call”?
One telephone has no value, the value is in the network – how can we
ensure that a network is ever created? Of course I'm oversimplifying
the comparison – but you can apply the concept to almost any innovation
– for the most part the innovation succeeds because it provides value,
solves problems, improves life in general. Once the market validates
an innovation, government may well have a role in regulating to promote
some level of efficiency. However, the reverse – seems more problematic
– government promulgating meaningful use and then turning it over to
the market to implement.
While I am hopeful that this latest
chapter will produce action, I am most encouraged by the growing recognition
of the role of the patient/consumer in the drive to automate health
information. No one has more interest in their health history
or health future than the individual health consumer. Physician
relationships may come and go, payer relationships are certainly transitional
– but the one constant is that most people want to be healthy and want
to live a long and healthy life. Personal involvement in proactively
managing health is essential to this outcome. As an industry,
we need to provide the tools and services and access to information
to consumers so that they can effectively manage their health – in collaboration
with all of their clinical resources. That, I believe is meaningful
use – health information available where and when it can positively
impact the health of an individual and advance the quality of health
across the population.
Earlier this week an organization called
healthdatarights.org issued a “Declaration of Health Data Rights”.
While the tenets of this declaration would normally be self evident
– I would suggest that this declaration be adopted and endorsed as a
foundation of our national drive to automate health information.
Actions like this may finally represent the break-through that has eluded
us since those earliest days in 1965.
Brian Baum was the co-founder of
the Health Record Network launched by Duke University in 2003, and most
recently serves as the President of Stayhealthy.