Semantic Web in Health IT

Brian Robinson has written an article on Semantic Web/Web 3.0 (although they are hardly synonyms) in GovernmentHealthIT. Dr. Parsa Mirhaji, director of the Center for Biosecurity and Public Health Informatics Research at the University of Texas, is quoted as saying: "people now have to log on to five or six different systems to get complete information about patients." The assumption is that when everything complies with Semantic Web that will be unnecessary, that this information will be linked semantically between systems. No more endless searches to find the information that you are looking for.

Mirhaji doesn't stop at simply integrating the information though. Computational models based on SW will allow computers to make inferences much like humans. One immediate use of SW is the ability to normalize the medical nomenclature; equating terms that mean the same thing.

Oracle is on the bandwagon and promoting the wonders of SW. Bob Shimp, VP of Oracle's Global Technology Business Unit, is hopeful that SW technologies will be in use in health IT in the next couple years.

RHIOs Call in Sick

Information Week's cover story this week, Diagnosis Critical, paints a pretty bleak picture of health IT in this country. At issue is the ability to exchange patient data between healthcare providers in a Regional Health Information Organization (RHIO). I mentioned a RHIO which I had personally experienced in a blog last January; the Integrated Physician Network (iPN) Avista. Although RHIOs have some advantages for providers and patients, the economics are not sufficiently compelling for hospitals to create them without grant funding.

The failure of a role model RHIO, the Santa Barbara County Care Data Exchange, at the end of 2006 highlights the problems facing RHIOs and the exchange of patient information. The problems ranged from too ambitious to lack of community support, but in the end the providers could not see the value in the network. SBCCDE spent eight years building their network, if they had been able to accurately predict the time and expense in setting up the system they may have been better able to set expectations. But had they possessed that information at the start would they have proceeded with the project in the first place?

Integrated healthcare systems, such as Kaiser Permanente and the UK's National Health Service, have strong economic incentive to streamline processes and reduce costs, motivating them to persevere even when struggling against daunting cultural and technical hurdles. But the loose federation of healthcare providers in the U.S. doesn't have those incentives; the costs of inefficiencies just get passed along to the consumers.

The American Health Information Community, an advisory group to the federal government, is expected to recommend that doctors using health IT systems receive higher reimbursement rates for treating Medicare patients. Although creating financial incentives to drive health IT is a powerful motivator, there are people who feel that nothing short of a government mandate will be necessary to drive adoption. I'm all in favor of holding out a carrot, but do we really think using the stick will speed the process?

What's Next, House Calls?

A story on the front page of yesterday's Wall Street Journal describes a physician in Rochester N.Y. who started up a solo practice with just an office and a computer. After working as a staff doctor in the local hospital for eight years, Dr. Gordon Moore figured it took 19 separate actions and 253 feet of walking just to order a prescription refill. With his new software he can order a refill with a few clicks and zero feet of walking. What's wrong with this picture?

The implementation of EMRs in clinical environments is often met with anxiety, resistance or ambivalence. Due to compelling economic pressures on large hospitals they are placed in situations where they are obligated to implement the systems, often at high expense and risk. Smaller practices take a wait and see approach; the economic need is not seen as so compelling as to off set the risk and the pain of implementing the new systems. As I explained in an earlier blog, some of these practices have needed significant subsidies to get their systems up and running.

But when you have an important medical service, such as primary-care healthcare, saved from dwindling numbers of care providers by the implementation of technology, the benefits are undeniable. The key is to find the right combination of systems to fit the current and near-term needs. This may be easier in a solo practice than one with multiple physicians with conflicting needs or perceptions.