In the past 12 months, we have seen the rise of social networking sites for physicians, growing enthusiasm for the concept of patient-centered medical homes, the roll-out of PHRs by major players like Google and Microsoft, a shift from medical search engines to general search engines, and the first wave of retail DNA tests. One thing we didn’t see in 2008 was major progress in physicians’ adoption of HIT. We tackle these topics and more in this review of some of the top health IT stories from 2008. 1. Let's Speed IT Up
Despite a number of efforts to promote HIT adoption, including studies showing the cost-savings that could accompany widespread HIT adoption; local efforts, such as Vermont’s Health IT Trust Fund
and New York City Mayor Michael Bloomberg’s charitable foundation
that provided $27 million for EHR adoption; continuous efforts by HHS
to increase transparency and adoption; and financial incentives offered by Medicare for e-prescribing, the fact is that IT adoption in healthcare is proceeding at a snail’s pace. Let’s review some lowlights from 2008:Jan. 18
: A report
from the California HealthCare Foundation said efforts to create a Nationwide Health Information Network are “impractical and cannot be implemented,” and added that “none of the [health IT] leaders interviewed for this report could point to substantial, real advances in the adoption and utilization of [health IT] since the president launched his initiative.”Jan. 24
: Only 4% of respondents to a physician EHR adoption survey
reported using a “functional EHR;” only 14% used a “minimally functional EHR.” Adoption rates were 35% in practices of 10 or more and 6% for solo practices.March 2
: The Baltimore Sun reported
that 90% of US physicians and more than two-thirds of hospitals still use paper records, putting healthcare in the country “at least a generation behind the rest of society in terms of technology,” according to David Merritt, project director at the Center for Health Transformation.July 18
: A Commonwealth Fund report
found that it will take more than 30 years at the current HIT adoption rate to expand clinical support tools to all US physicians.Aug. 31
: An American Hospital Association survey
found that although 68% of US hospitals have implemented some type of EHR, most are only used in parts of the facility.Oct. 30
: According to a Healthcare Information and Management Systems Society survey
, roughly 30% of physician group practice administrators said they have functional components of an EHR in place in their organization, up just 4% from 2006.Nov. 11
: A survey
presented at the American Health Information Community meeting showed that between 2% and 12% of US hospitals use EHRs, depending on how the term is defined.2. MDs Are Going Ga-Ga over Google
It is becoming increasingly difficult to stump medical students on clinical rounds nowadays; they always seem to come up with the correct diagnosis, in part because they are particularly adept at finding the right information as quickly as possible using the Internet.
Search engines are extremely useful, because they can take a query, find the words that match, and put them together into an outcome that makes sense. Unlike medical search engines that rely on keywords, from the author and the researcher, the Internet looks at all of the words entered and makes no judgments as to their value. Your words are just as important as the authors’, though there is some contextual awareness.
Google makes no judgments unless you misspell a word, and it will then suggest a correction. It allows you to search the way you think, not how the author was thinking. Occasionally, you will type in a query, find the article, and get blocked because the publisher wants you to pay to view the content. To solve this problem, simply take the article citation and search through secondary sources at a university, hospital, or office library to do the PubMed or Ovid search.
I am preparing to take my recertification in geriatrics, and during the individual self-evaluation medical knowledge modules, Google and Google Scholar were my best friends. When there was a question I needed help with, these search engines gave me the easiest way to find the right answer. If a keyword is obvious, and you search Ovid, PubMed, or Up-To- Date, you might narrow your query but still might be unable to find the quote. With Google, you type in the quote, and the article pops right up.—By MDNG editorial board member Eric G. Tangalos, MD