Looking at health IT roadblocks

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The vision of how health IT should become a reality for clinicians and patients has not changed much in several decades, according to Edward Shortliffe, MD, PhD, of the College of Physicians and Surgeons, Columbia University. Shortliffe’s speech this week at the Health Information Technology (HIT) Symposium at MIT in Boston, Mass., focused on the barriers to implementation in the United States that have meant that health IT – something he and others envisioned being implemented in not too different a way nearly 30 years ago – remains largely out-of-reach.

This is because, said Shortliffe, health IT “doesn’t feel like medicine to a lot of people” and is largely regarded as a “secondary issue.” Another problem is that IT is often not seen as a strategic asset at many healthcare facilities, and it is also seen as a threat to patient data security. The reality is that “IT provides much more protection than risk,” he said, noting that thankfully these perceptions, overall, are beginning to change.

Other barriers have to do with the culture of healthcare itself. Many providers fear that health IT might depersonalize care which is something of a “red herring,” said Shortliffe, as the truth is that most patients actually expect automation these days.

One fear that is legitimate, he said, is that IT systems will require physicians and other to learn new skill sets in unfamiliar areas of expertise. Vendors that design these systems should make a note of including such fears in future designs to gain provider acceptance, Shortliffe said.

As for getting the support of decision makers at facilities, one key thing to address is the very way that IT systems are viewed to begin with. It should be emphasized at healthcare facilities that IT systems are medical devices and not just IT projects, said Shortliffe.

Some of the health IT implementation roadblocks that are occurring nationwide have to do with the structure of the healthcare system in the United States as a whole, made more complicated by the fact that the country is split by 50 different sets of state law that do not necessarily agree.

Shortliffe is of the opinion that the U.S. healthcare system is highly fragmented as compared to those in other countries, and this has partly to do with the fact that organizations in the industry are very sophisticated social environments. For instance, IT users do not necessarily work for the organizations that provide the system, caregivers do not generally participate in standards creation – thus integration within organizations and across institutions is difficult, and not enough people in the industry have knowledge that would enable them to “work effectively at the intersection between biomedicine and IT,” said Shortliffe.

Despite all of these barriers, the climate is ripe for change in the industry, due largely to increased consumer activism, standards, and cracking down on medical errors through IT usage. There also has been a lot of legislation activity, the pay for performance movement, “confirmatory reports and recommendations” from various organizations, and other events that have contributed to this climate change, said Shortliffe.

For all of this to happen the “government must play a key role along with industry,” said Shortliffe, adding that “the competitive nature of the medical marketplace, coupled with fiscal pressures on providers and health systems, means that leadership for regional and national coordination will need to come from elsewhere.”