IT Session Citizens' Health Care Working Group July 22, 2005 Salt Lake City, Utah Stanley M. Huff, M.D.

Acknowledgements T. Allan Pryor, Homer Warner Sr., Reed Gardner, Paul Clayton, Brent James, R. Scott Evans, Roberto Rocha, Harold Solbrig, Wade Barnes, Lee min Lau, Peter Haug, And many others …

Who am I?  Clinical pathologist by training  AT&T Bell Laboratories  Role at Intermountain Health Care – Clinical System Architect  Other activities – Professor (Clinical) Medical Informatics, University of Utah – Past Chair of Health Level Seven (HL7) – Co-chair of the LOINC (Logical Observation Identifier Names and Codes) Committee – Former advisor to the SNOMED Editorial Board – Member of the National Committee on Vital and Health Statistics

Intermountain Health Care (IHC)  Not for profit corporation  22 Hospitals – 500 to 25 beds – ~ 1.8 million patients/members  Ambulatory Clinics  14 Urgent Care Centers  Health Plans Division (Insurance)  Physician’s Division (~450 employed physicians)

Human Limitations ‘... All confirm what would be expected from common sense: The complexity of modern medicine exceeds the inherent limitations of the unaided human mind.’ David M. Eddy, MD, Ph.D. Clinical Decision Making JAMA 263: , 1990

Imperfect Man ‘... man is not perfectible. There are limits to man’s capabilities as an information processor that assure the occurrence of random errors in his activities.’ Clem McDonald New England Journal of Medicine 1976

Advances in science  Thermometer – Understanding of heat and entropy – Steam engines  Piles (batteries), magnets, copper wires – Understanding of electromagnetism – Electric lights and motors, computers  Measurements on the speed of light – Special and general theories of relativity

A thermometer for Medical Care  Integrated standards for medical data models and terminology are the thermometer that we need to fund and create today. We will be able to “see” and “hear” things that we can not detect today. It can be done for a trivial fraction (a rounding error) of the billions spent on health care and clinical research.

Clinical Info Systems at IHC (Roberto Rocha)  HELP System – Comprehensive HIS with extensive collection of decision support modules (“frames”) Operational for the past 30+ years 13,382 unique users (Aug 2004)  HELP 2 System – New EMR (replace core HELP functions) Operational for the past 5+ years (initial outpatient focus) 5,224 (Web) + 2,519 (CW) unique users (Aug 2004)

July 2004: 4,926 unique logons

Conclusion  Proper application of information technology can increase the quality of care while decreasing the cost

Recommendations  Continue to invest in research and development of health care information systems  Create incentives for cost effective use of electronic health record systems  Fund the creation of standards that allow sharing of data and decision support logic

Dependencies  Standards – Data exchange standards (HL7, DICOM, NCPDP, IEEE) – Terminology standards (LOINC, SNOMED CT, RxNorm (clinical drugs), UMLS Metathesaurus, FDA drug identifiers) – Decision logic (Arden Syntax, Gello) – Common services interface