The merging of health care with state-of-the-art information technology will solve some problems in medical care, but it will create others in the data centers needed to support this electronic records system.
Unlike most corporations, where policies can be established to purge data that lasts beyond a certain point, medical records last for at least the life of the patient and often beyond. Epidemiological studies are being done by some hospitals based on more than a century of records.
Forbes caught up with Geoff Brown, CIO at Inova, a nonprofit hospital group in Virginia, to talk about the changes in store for IT departments.
Forbes: What does this do for your IT systems? It sounds like storage needs will skyrocket.
Brown: If you’re in health systems, you probably have a fairly robust IT infrastructure already. But there is a fair amount of middleware you have to add to your environment for all of this storage–interfacing between all these different electrical medical records, labs and tax imaging systems. The good news is it’s fairly well-scripted. Over the past five years, applications and infrastructure have been adopted to allow this to happen.
It’s comparable to the banking industry: When ATMs first came out, there were one or two vendors. Over time, others got involved, and they developed standards. The language was the same. We debited and credited the same way, so it worked everywhere in the country. The same is happening in the health system today. Information flows two ways, and that’s one of the key components of the [federal] stimulus package–meaningful use demonstration.
Is there anyone overseeing this?
CCHIT [the Certification Commission for Healthcare Information Technology] certifies electronic medical records systems. Health care systems are tightly regulated. In 2007, there was a relaxation of the guidelines that allowed hospitals to underwrite the costs of physicians. President Bush dictated that by 2014 all health systems would require electronic medical records. So work started in 2007, but very few people reacted because we needed a ruling from the IRS. What these companies need is not just information from health systems, but information from the field, as well, where there are individual physicians’ practices. In northern Virginia, we’re at 12% to 15% adoption levels, which is ahead of the rest of the country but nowhere near critical mass.
When will it reach critical mass?
With the stimulus money, we think you’re going to start seeing very aggressive adoption of technology. The standards just weren’t there. A three-physician practice might have to spend $50,000 to $80,000, and then still have to pay for back-office support and IT. A lot of these businesses didn’t have the capacity to do it. A lot of large specialty groups did that, but smaller groups didn’t have the wherewithal.
And this is complex technology, right?
It is not simple software. But we’ve seen more and more willingness on the part of the medical community to adopt evidence-based practice. A few years ago, this was being called “cookbook medicine.” But when a physician group goes from a paper-based work flow to an automated one, it changes the rules in a practice. For the first two to three months, there is actually a reduction in productivity.
Now you’re going to be storing images, too. Is your storage exploding?
It is exploding. There is very strong compression technology to reduce the footprint of these arrays, but due to performance requirements from an extraction and reference perspective, you need a fairly robust storage environment to make it all work. A few seconds between queries is about all you can allow. And it’s very expensive to make this work right. You can’t just add on. You have to worry about performance and caching. In health care, those imaging files are the most challenging to manage.
And you can’t purge the system, right?
That’s right. We don’t ever get rid of any of it. But you can layer the storage. For three years, you put it in heavily cached storage arrays. As it ages, you step it down. When you get to the third level, you can use almost platter-speed storage. We just automated our emergency department. Before we had automation, someone would come in, they would take their application, find out their illness. They would see a physician based on that information. And they would write you an order to get an X-ray done. And then you would wait until it was read by a radiologist. Now, when that radiology image is done it’s instantaneous. We’ve gone from a couple hours to minutes for this whole process, and that image is embedded right within the patient’s records.
There are huge efficiencies there with labor and materials, and there is less administrative overhead. We also added a Picis system [an application that combines clinical, financial and operational data, which is roughly the equivalent of ERP in commercial enterprises] into our emergency departments over the past 18 months.
How about security? Are the systems more secure than paper or the previous systems?
The systems we’re using now are more secure. But when you get to deployment, you still have to build a security framework. Typically, if a physician comes into my facility, a two-level authentication has to take place. They have to log in, and if it’s not a secure connection, they have to log in to our network and obtain a pass based upon their authorization level. They can then get a password to log in. For most organizations, we have a secure connection. In most cases, it’s encrypted. The data goes out of the network encrypted and it couldn’t be unencrypted until it gets to the other end. That’s what most people care about. It’s not the worry about efficiency or cost. It’s the security of their information and not wanting personal data available in the open market.
It sounds like you’re using technology that is similar to what banks are using.
Yes, we are. And anything less than that won’t fly. You’ll be hearing about regional information health organizations, or RIHOs. They’re acting as independent brokers of that information between disparate systems. In northern Virginia, we’re creating our own RIHO. We’ll be looking to exchange that information with Washington, D.C., and Maryland, so as people move around our region we’ll be able to serve them.
One day there will be a national version of this. It really mirrors what happened in the financial industry. There will be structured records with universal standards. Once that happens, if we were to get hit with bioterrorism, those alerts would begin to go off and people could escalate it to the next level. We’re seeing some of that even within the confines of our organization. It’s a great direction, but right now, it’s too expensive for many to get there, and changing from a paper-based world to an automated one is no simple task.