Health Care's Sore Need for Standards

I'm in Tokyo lecturing about the need to implement electronic medical records to provide safe, efficient and coordinated medical care. Interestingly, I can walk into any Japanese post office, insert my ATM card (issued by a rural New England bank) into any cash machine and retrieve as many yen as I need. This is made possible by the worldwide adoption of electronic standards for banking and cash transfers.

However, in my hometown of Boston, my medical records can't be electronically exchanged between two of the world's best teaching hospitals, even though they're across the street from each other. This is because there hasn't been consistent adoption of standards for the storage and exchange of medical information in the U.S. But there's hope.

Health and Human Services Secretary Michael Leavitt has established the American Health Information Community, a group of 17 government, business and nonprofit leaders charged with fostering adoption of interoperable electronic records throughout the country. Further, the HHS-based Office of the National Coordinator for Health Information Technology has funded a $17.5 million effort to accelerate electronic medical record interoperability. This effort comprises three parts.

The first is to harmonize all the electronic standards for health care in the U.S. There are over 100 U.S. organizations creating standards. These standards are at times redundant, competitive and noninteroperable. To achieve the kind of universal functionality our ATM cards provide worldwide, U.S. parties must agree on a common set of health care data standards implemented consistently by hospitals, clinician offices and nursing homes.

The second step is to standardize privacy and security policies across all 50 states. In Massachusetts, doctors can't retrieve a complete electronic medical list from an insurance company, even with patient consent, if a medication related to mental health, substance abuse or HIV treatment is present. In Ohio, doctors must use a cryptographic electronic signature to prescribe medications electronically. In California, only paper forms are considered a valid patient consent. The laws that created many of these regulations were appropriate 30 years ago, when electronic systems lacked the sophistication available today, but now they're an impediment to delivering safe, patient-focused care.

The third step is to ensure that electronic medical records provide the basic functions needed for a doctor to record and transmit patient medical information. The average patient over 80 has 10 medications and three clinicians. Rarely is there any coordination of care among caregivers. Objective criteria to certify that an electronic records system meets the basic requirements for data capture and exchange are essential.

These steps are a great start. However, there's a major disconnect in Washington. President Bush has stated that every clinician should be using electronic medical records within 10 years. The U.S. is pursuing this goal with $100 million. The U.K. has funded a similar effort with £6 billion. It's estimated that the U.S. could save over $100 billion yearly by using interoperable electronic medical records, making the return on investment a no-brainer.

It's time that we achieve the health care equivalent of the ATM card. If Japan and the U.S. can coordinate complex currency exchanges between Japanese post offices and rural U.S. banks, we should be able to send electronic medical records across the street. Now is the time to make the investment. Your health depends on it.

John D. Halamka is CIO at CareGroup Health System, CIO and associate dean for educational technology at Harvard Medical School, chairman of the New England Health Electronic Data Interchange Network, CIO of the Harvard Clinical Research Institute and a practicing emergency physician. Contact him at

Copyright © 2005 IDG Communications, Inc.

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