Beyond Medical Informatics

(This is Part 1 of a modified version of a loooooong comment I posted in the FB group page of the Philippine Medical Informatics Society. Here is Part 2.)

Premise:
Some members of the group proposed that a National Health IT Framework with official standards, technology and IT systems design would improve the Healthcare IT situation of the Philippines. They compared how US HIT is in a mess because it did not have these national frameworks when they started working on their Health IT systems.

My short version reply:
The US situation statement is an oversimplification. And a source of wrong thinking. Everyone needs to get out of that thinking that IT-specific policies will ‘correct’ what’s wrong with the state of Health IT in the Philippines.

My long version reply:

Health IT implementations come in different sizes but should still reside in a continuum of complexity. Small scale implementations can start from 1-user EMRs to small hospital settings. Large scale implementations can go from hospital networks to national implementations.

The “IT Perspective” would be to look at the technology needs (frameworks, standards, etc.) that each level of implementation requires. But the “Management Perspective” knows that the critical factor is to identify the different goals, objectives and desired results for each level.

Here’s a good mental exercise at this point. What would be the goals and desired results of:

• a single doctor EMR system?
• an LIS-HIS integration project?
• a Cancer Center EMR?
• a clinical data repository for a network of hospitals and clinics?
• a National EHR implementation similar to Singapore?

Each one would have different goals, priorities and objectives as compared to the others.

My short version reply was about common misconceptions of the role of policies in Health IT. We compared the PH scenario with US scenario. And this is where most get it wrong.

Many advocated the creation of national level “IT Perspective” policies, e.g. what standards we should follow, what format, what technology, what system etc. But the US national policies did NOT start like that. They were crafted from a “Management Perspective”. They identified and mandated a set of results and goals. Here are over-simplified samples:

• Medicare required better clinical documentation. EFFECT –> This lead to boom in EMR and medical transcription. (Did they say how hospitals should implement it? Not really.)
• Health insurance required more accurate diagnosis codes. EFFECT –> This lead to adoption of DRGs, ICD9-CM, CPT. Will need software to manage.
• Joint Commission identified goals for different areas. EFFECT –> Different implementations possible to achieve results. Some use IT. Some do not. Using IT proved easier.
• HIPAA mandated security and privacy goals. EFFECT –> Mostly achieved by EMR software. (There is no HIPAA-compliant software, only HIPAA-compliant organizations. Organizations looked into IT to comply with regulations.)
• ARRA/Meaningful Use/HITECH defined goals—and incentives!—in use and adoption (NOT the technology or interoperability standards). EFFECT –> Increased rate of EMR adoption.

There are plenty more stories and samples from the history of Health IT in US and other countries that drive the point. Basically, they FIRST identified the RESULTS they wanted to achieve at the level they wanted to implement. The did not go and create a policy for standards and technology without first identifying the need for it.

Let me emphasize: Having a clear set of results is MORE IMPORTANT than a clear set of tools.

(Please proceed to Part 2 Conclusion.)

Related posts:

1. HIT Idea: 5-year Strategic Health IT Plan
2. HIT List: National Health IT Plans in other countries