The Road To Integration

The advancement of IT within health care is occurring rapidly, fueled by national, state, and regional initiatives designed to reduce medical errors, improve patient care, and decrease costs. The University of Pittsburgh Medical Center believes IT should serve as the catalyst and enabler to accomplish these goals. As such, it's investing more than $500 million to develop technology for integrated, multimedia electronic health records that will provide patients and their doctors with access to complete medical records. The medical center, along with government agencies and health-care organizations, is undertaking collaboration and integration efforts to share clinical patient data in various formats across disparate systems.

Health and Human Services Secretary Tommy Thompson, in conjunction with the departments of Defense and Veterans Affairs, is leading the charge to implement common national health-care standards as part of Thompson's move to create the National Health Information Infrastructure. Both clinicians and technologists from the University of Pittsburgh Medical Center participated in a National Health Information Infrastructure public-private collaborative conference earlier this year.

Secretary Thompson commissioned the Institute of Medicine, part of the National Academy of Sciences, to design a standardized model of an electronic health record. The health-care standards development organization, Health Level 7, evaluated the model but refused the initial proposal, calling it overly complex. Still, the University of Pittsburgh Medical Center believes that with minor modifications, this initiative will be instrumental in advancing the national health-care agenda.

After standardization, the challenge will be how to get IT systems across the private and public sectors to communicate. Numerous "official" clinical vocabularies have made it difficult for health-care organizations to centralize patient records and have complicated public-health efforts to monitor patient symptoms and potential disease outbreaks. Health and Human Services licensed Systematized Nomenclature of Medicine, or SnoMed, from the College of American Pathologists to standardize medical terminology to provide effective treatment guidelines.

Other initiatives have been developed to standardize communication among health-care entities. The X12 837 code set for standardized electronic claims mandated under the Health Insurance Portability and Accountability Act potentially could save the industry $30 billion, according to federal estimates. The University of Pittsburgh Medical Center's insurance division is prepared to accept the standardized claims from participating providers. By linking payers and providers with electronic workflow, the industry can reduce transaction costs from $5 to less than 25 cents per transaction, experts say. The medical center is also involved in Connecting for Health, a public-private effort that's mobilizing information to improve quality of care, conducting timely research, empowering patients to participate in their care, and bolstering the public-health infrastructure.

In a benchmark collaborative effort between an academic medical center and a branch of the U.S. military, the University of Pittsburgh Medical Center and the U.S. Air Force Medical Service have created a strategic partnership focused on using advanced technologies to provide health-care services regardless of location. The partnership was initially funded by an appropriation in the U.S. defense-spending bill for 2002. The existence of common standards across institutions both regionally and nationally will be instrumental in making this project effective. The applications and processes developed will be replicable and scalable on a national and international level.

Developing common standards for health-care access, communication, and collaboration isn't easy, but the opportunity cost of not doing so is high. If the goal of sharing clinical information nationally is to be reached, health-care professionals across the country need to actively participate in the development of a unified set of standards.

Daniel Drawbaugh is CIO of the University of Pittsburgh Medical Center, which ranked No. 37 on this year's InformationWeek 500 list of the most innovative users of business technology.

Photo of Daniel Drawbaugh by Jim Judkis