The medical profession is replete with technologic advancements. In fact, it encourages and promotes it. Cardiologists can thread wires no thicker than a piece of thread into the blood vessels of your heart to help restore blood flow; surgeons can sew together vessels with sutures no thicker than a hair. Imaging machines can use x-rays or even just magnetic fields or sound waves to recreate three-dimensional models of the human body down to the millimeter level. One can now swallow a camera-containing pill that will provide a complete endoscopic picture of the intestinal tract without the need for endoscopes. Robotic surgery raises the possibility of surgery in remote locations, perhaps even off the planet. The list is endless.
So how can it be that one of the greatest advances of the late twentieth century – information technology – has so successfully eluded the medical profession? On one level, the profession has certainly embraced these developments. The rapid progress in computer data processing power drove the Human Genome Project to describe the structure of human DNA a whole decade ahead of schedule. Computerized imaging has become standard and is advancing at a rapid pace. However, the simple transfer of medical records into an electronic format lags behind virtually every other profession in the modern world. One can go to a machine in Europe or Asia with a plastic card and draw money from one’s bank account in Miami, based on the securely stored information which is transmitted. However, one cannot go the hospital down the street from the one he was admitted to last week and expect there to be any information whatsoever available at the new facility regarding his previous admission or medical history.
If we leave aside the IT mystique, we are probably left with three reasons for this situation. (What is the “IT Mystique”? Traditionally, specialists in information technology relied on general lack of knowledge and confusion and sheer awe regarding computers and how they could be utilized in the storage and transmittal of information to secure their position as the “gurus” – the only people who could understand what was going on or solve problems. This was a great way to make oneself invaluable, but a poor way to introduce change and advancement.) First, personal medical information is very precious material.
Information regarding one’s life expectancy, risk of various conditions (or genetic predisposition to various medical conditions), or current health status could have radical impact on one’s insurability, employability or even possibly, desirability for personal relationships. In short, the availability/access to one’s health information cuts to the core of personal privacy in our society. The exigencies of privacy are in conflict to the needs of accessibility and transfer. Secondly, there is no uniform “language” or definition of terms within the medical profession. What one electronic record collects as date of birth, the other might collect as age. Without a cognitive interface to understand that both are describing the same piece of information, one cannot communicate with the other. Information systems have been developed in independent silos. Even though there is a currently developed medical language, it is not in common, to say nothing of uniform usage. The future will require either uniform standards and/or more sophisticated search engines so that systems can communicate with one another. Lastly, the cost of transition—both in dollars and in additional man hours of training and “down time” learning the new system, have provided considerable negative inertia to change. Current federal mandates are providing economic incentives (for a few years, to be followed by economic punishments for nonperformance) for transition. Despite this, only approximately 10% of hospitals currently have a completely electronic medical record system; only 2% are compliant with the newly mandated HITECH (health information technology for economic and clinical health) meaningful use guidelines.
However, if we are to advance as a profession, it would seem that we must begin to apply the same rigor and resources that we have traditionally applied to generating information, to the science and technology of transmitting that information in clinically and scientifically meaningful ways.
