Health IT moving to critical step

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The first boom in health information technology began in 2009 after the Obama administration's Health Information Technology for Economic and Clinical Health Act began pumping billions in subsidies toward hospitals and doctors' offices.

The second boom? It's happening now, say experts who spoke at a Thursday conference on the state of the industry, organized by Philadelphia's La Salle University and held in Chester County.

Much of the last four years have been spent installing the hardware and software necessary for the collection and transmission of electronic medical records. Next comes the significantly more difficult task of getting all of those systems to communicate with one another and to cull all of that interconnected health data in meaningful, prescriptive ways.

"There are just so many changes that have come down the pike since the HITECH Act was passed," said William Gillespie, director of health care solutions at Distributed Systems Services Inc., of Berks County. "It just continues to roll."

Farzad Mostashari, the former national coordinator for health IT at the U.S. Department of Health and Human Services, called 2014 "a make-or-break year" for electronic health records, according to Bloomberg News Service. Providers that accept Medicare patients and receive Medicare reimbursements -- which is almost all of them -- will see reduced payments starting in 2015 if they haven't digitized their records in some way. Vendors will soon have to meet tougher certification standards.

Easier said than done. The trick will be making sure that the oncoming spending boom doesn't turn into a performance bust.

"From the HIT standpoint, a lot of these systems aren't up to all of this interoperability," said Susan M. Salkowitz, a principal and health information technology consultant at Philadelphia's Salkowitz Associates, in a telephone interview. She, too, presented at Thursday's conference.

"It's something that's talked about a lot" in health care, she said. "There's a huge gap between promise and performance."

The promise is that digitizing loads and loads of patient data will reduce costs, reduce duplicative tests and office visits, increase patient satisfaction and, most importantly, improve health care outcomes. Clinics big and small will be able to compare the health of their patient populations against the community at large. Records systems will be able to make suggestions to physicians. Patient populations can be monitored from birth to death, leading to more rapid public health breakthroughs.

In other words, all providers are about to enter the era of big data and analytics, something heretofore in place only at large hospitals and health insurance companies.

"We want to have patients at the center [of] decisions we make," said Thompson Boyd, physician liaison at Hahnemann University Hospital, also a Thursday presenter.

But those decisions will be supported by increasingly sophisticated systems, he said. At the same time, patients will, if they so desire, have greater at-home access to their own medical records, allowing them to be more involved in their care.

The coming boom will bring many challenges. One is storage -- as patient data is accumulated electronically, it has to be saved somewhere, permanently. Another is security -- not just of patient records, but medical devices themselves. Many pacemakers have wireless radios that can be hacked, for example. Apps and mobile devices, each with their own security issues, are being developed in droves.

A third challenge is talent. Across all sectors, the demand for "deep analytical talent" (people who can analyze big data sets and draw meaningful, actionable conclusions) will outstrip supply by as much as 50 percent, or 140,000 to 190,000 analysts, by 2018, according to McKinsey & Co. consulting firm.

All of this security, storage and talent comes at a cost -- and that might be the biggest challenge of all. Many experts predict the capital demands of the health IT revolution will force even more mergers among providers as well as vendors.

"It's not once and done," Mr. Gillespie said. "You have to continue to invest in information technology."

To date, the federal government has spent more than $17 billion on electronic medical records incentives and subsidies.

Bill Toland: or 412-263-2625.

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