Health IT Hits a Wall

It's hard (for me, at least) not to click on the headline "Up to half of Spanish-translated prescriptions include dangerous mistakes" as a May 12 Fierce Healthcare post declared. The post cited a recent Pediatrics study that found that translation programs used by pharmacies to create Spanish-language instructions for patients were deeply flawed.

The Pediatrics study evaluated Spanish medicine labels from 209 pharmacies in the Bronx, New York; most of the pharmacies used computer programs to translate instructions for patients from English into Spanish. Half of the the translated labels used a mixture of Spanish and English, or had grammatical or spelling mistakes, resulting in "inconsistent and potentially hazardous" translations, according to the authors.

"Phrases that were not translated included 'dropperfuls,' 'apply topically,' 'for 7 days,' 'for 30 days,' 'apply to affected areas,' with juice,' 'take with food,' and 'once a day,'" the Pediatrics study's authors wrote. Mistranslated phrases included the substitution of "eleven times a day" for the phrase "once a day."

The move toward e-prescribing, electronic medical records, and other technological advances is supposed to make the practice of medicine safer and cheaper. The famous 1999 Institute of Medicine report, "To Err is Human: Building a Safer Health System" which found that up to 100,000 people die in hospitals each year from medical errors, helped shift the needle toward more standardization and digitization of medicine.

The Centers for Medicare and Medicaid (CMS) encourages the adoption of electronic medical records (EMR) and will soon provide financial incentives to health care providers who adopt them. In February, FierceHealthIT pointed out that "a healthy $20 billion in IT spending [from the stimulus bill]... will largely be funneled through CMS to provide incentives for EMR adoption."

All good, if you support health care reform and patient safety. But throwing technology at problems has its limitations, as the Pediatrics study makes clear. The study's authors suggested more regulation of and funding for better translation programs. Meanwhile, other unresolved IT issues, such as ensuring the electronic security of patients' health information, will continue to pose challenges for health IT for a long time to come.

Google Flu Data Rivals CDC

Last week, internet search giant Google released the Google Flu Trends tool, which tracks possible flu outbreaks by compiling data on how often people use flu-related search terms such as "flu symptoms" and "chest congestion". Google Flu Trends provides raw data, but not context. Each year, close to 100 million Americans search for health information online, but not everyone who searches for health information is injured or ill. Since I write about medicine, for example, I usually search for health information online for my writing projects, not personal knowledge. Other searches, it seems, might be done out of idle curiosity, or even result from a keystroke error in the search bar.

Is Google Flu Trends just another odd little Google project that their employees tinker with at the Googleplex in Mountain View in between running the search engine and scanning in every book ever written? Apparently not. Google mapped five years' worth of their flu data against flu data from the Centers for Disease Control and Prevention (CDC), which the agency compiles from health care providers, emergency room visit statistics, and other sources. Data from Google correlated closely with CDC data, often predicting flu outbreaks a week or two before the CDC. Google will soon publish a paper on its methodology in an upcoming issue of Nature.

Health care researchers already search for trends in anonymized electronic medical records (EMRs) that some practices use to record patient medical data and prescriptions. More digital data will become available in the future as EMRs become more common (especially since the federal government is providing financial incentives for Medicare providers to adopt e-prescribing, starting in 2009) .

For various reasons, however, many patients are not entirely honest with their doctors about their symptoms and medical concerns, a problem health care providers have struggled with for years. A patient might be embarrassed about a medical problem, forget to mention a symptom, or simply not realize that a symptom is significant. For this reason, search engine data might provide an even larger, and potentially more accurate, data pool than EMRs to indicate the actual incidence of conditions such as pre-diabetes or early heart disease, for example. Public health officials could then use the data to create more effective screening and prevention campaigns.

Good Technology, Bad Technology

When I pick up the phone, the friendly woman's voice greets me in Russian. Or maybe it's Romanian? Or Polish? Then she begins a long discussion about an upcoming medical appointment in the mystery language. I know this because she mentions my name and a local medical center in English. She calls about once a month, a glitch in some health care provider's electronic appointment reminder system.

Ah, medical information technology. I still can't decide whether I like it or not. At my daughter's pediatrician's office, I wonder why they're still using a giant, scribbled-over paper appointment book and paper folders to hold medical records. Then I remember that a shift to appointment scheduling software and electronic medical records could mean technology glitches like my periodic Russian phone calls and the imposition of a laptop screen between the doctor and me when we talked. On the other hand, I reason, it's incredibly useful when a doctor I'm visiting can pull up electronic test results from another doctor I saw recently. Yet this easy access is also creepily Orwellian. How many people, exactly, do have access to my medical information? And what are they doing with it?

Sometimes, medical IT practices can cause real harm. A recent article in JAMA analyzed how radio frequency identification (RFID) devices, used to identify patients and equipment, can also interfere with medical equipment used to treat and manage medical problems. My daughter and I received RFID wristbands when she was born, in order to make sure that no unauthorized person took her from the hospital. Could the wristbands’ signals have interfered with the lifesaving equipment used on the infants in the neonatal ICU down the hall? Possibly, according to JAMA.

As I sort through my own opinions about information technology and medicine, the technology marches forward relentlessly. At the moment, the Markle Foundation, a public/private collaborative studying IT, health, and national security issues and endorsed by WebMD, the American Academy of Family Physicians, Microsoft Corporation, and others, is analyzing the public/private world of digital personal health information in an age of many grievous privacy breaches. The foundation has developed privacy guidelines for health information and services that consumers use online. With care, I think, health care IT will improve, but only in the way that medicine improves: by trial and error, educated guesses, and unanticipated consequences.

The VA and Soldier Suicides

Yes, here I am dipping my toe into health care policy once again. But I can’t help but react to the announcement this week from the National Institute of Mental Health that suicide rates among soldiers and veterans who fought in Iraq and Afghanistan might exceed combat deaths. As of May 7, 2008, the Department of Defense casualty statistics state that 4,071 soldiers have died in the Iraq conflict, and 492 have died in the Afghanistan conflict. Veterans Affairs secretary Dr. James Peake admitted to Congress this week that there are probably over 1,000 suicide attempts per month by patients within the VA system. In 2007, a VA official said that only 790 soldiers attempted suicide that year; the VA has been accused of under-reporting suicide rates.

Technical and medical advances have greatly improved survival rates for soldiers injured on the battlefield, but as a result there are more seriously injured veterans to treat within the VA system, according to Government Executive.com. A RAND Corporation study estimates that about 300,000 returning Iraq and Afghanistan soldiers have post-traumatic stress disorder (only half receive treatment for PTSD), and 320,000 have a traumatic brain injury.

I remember that in 2006, the VA was widely praised as a model health care system. In fact, I assigned a story on this very topic to a freelance writer I worked with. The VA boasted an efficient, timesaving electronic medical record (EMR) system, geographically widespread facilities, access to and support of new medical treatments and techniques, and lower prescription drug costs than many private health plans due to bulk drug purchases. The VA has been considered a possible model for a nationwide universal health care plan.

Its image has been tarnished more recently, with the mismanagement and neglect at Walter Reed Army Medical Center reported by the Washington Post in 2007, for example. There is currently a class-action lawsuit against the VA in San Francisco, contending that the VA provides inadequate mental health services. Furthermore, many middle-income veterans and their families are ineligible for VA coverage, due to enrollment restrictions imposed by the Bush administration in 2003, Physicians for a National Health Program told Forbes.com last year.

The fundamental problem is limited funding, which threatens the VA every year. This problem will only get worse as soldiers continue to return home with complex and expensive mental and physical health problems. The suicide rate is a stark reminder that the VA has failed to help these people.