National Committee on Vital & Health Statistics

1. National Committee on Vital & Health Statistics Testimony of Reed M. Gardner, PhDProfessor and Chair Department of Medical Informatics, University of Utah, Co-director of Medical Informatics at LDS Hospital in Salt Lake City, UT and Past President of American Medical Informatics Association (AMIA) December 8, 1998

2. Transcribed Dictation ICU/SURGERY Nurse Care Plans Pulse Oximeters Infectious Disease Nursing Procedure Charting Ventilators KNOWLEDGE DATABASE Pharmacy Mixed Venous Saturations IV Pumps ECG Lab DECISION MAKING PROCESSOR, DATA AND TIME DRIVER MIB Data Bedside Monitors INTEGRATED CLINICAL DATA BASE Surgery & Anesthesia Charting Physiologic Data X-Ray Laboratory Blood Gas Lab Data Review Alerts Computations Interpretations Protocols Pathology Surgery Schedule Blood Bank Admitting Catherization Medical Records Respiratory Therapy OUTPUT

4. Adverse Drug Events DOWN 30% Mortality Rates DOWN FROM 3.65 to 2.65% Overall Antibiotic USE DOWN 22.8% Antibiotic costs per Patient DOWN 42% Computer-Assisted Antibiotic ManagementAnn Intern Med 1996; 124:884-890

5. Use of the computer has helped to reduce inappropriate antibiotic use and adverse drug events!

6. “When it comes to gathering information, medicine has not evolved much from the hunting and gathering stages of social evolution”. Clement J. McDonald, MD June 1994 6

7. #1Multiple sourcesof the sameinformationproduce differentvalues. 10 Potholes in the Road to Information QualityAdapted from Strong, Yang, and WangIEEE Computer August 1997, 30:(8)38-46. Example: When a hospital uses two separate procedures to assess severity of illness.

8. #2 Information is produced using subjective judgments, leading to bias. Example: When medical coders use their independent judgment to select disease codes.

9. #5Distributedheterogeneoussystems lead toinconsistentdefinitions,formats, andvalues. Example: Different systems in each division, each using a different format for diagnostic codes.

10. #8As informationconsumers’ tasks andthe organizationalenvironment change,the information thatis relevant anduseful changes. Example: The basis for insurance reimbursement to hospitals changes (capitation of care), requiring changes in information processes and systems.

11. “Adaptation” of Genesis 11:1-7 Tower of Babel Go to, let us go down, and there UNconfound their language, that they may not understand one another’s speech.

12. “Adaptation” of Genesis 11:1-7 Tower of Babel And the whole earth was of one language, and of one speech.

13. What does the HIPAA Legislation Call for? Development of a “language” and structure so that we can exchange clinical and administrative medical data within a clinic, hospital, health care enterprise and a community!

14. How should such “standardized language” be established? Two possibilities: 1. Development by “private” standards organizations. 2. Development by “government” sponsored standards organizations.

15. Advantages of Development by “private” standards organizations. 1. A currently existing methodology. 2. Concensus methodology used.

16. DISAdvantages of Development by “private” standards organizations. 1. It is taking TOO LONG. 2. It is TOO IMPORTANT to wait. 3. Standard developed will be “controlled and owned” by the organization that develops them. 4. There is a “conflict of interest” in development groups. 5. Perpetuation of and updating of standards are not guaranteed.

17. Advantages of Development by “government” sponsored standards organizations. 1. It can occur more quickly. 2. “Ownership and cost” would be clear and not be expensive. 3. A “Board of Standards” could be established to perpetuate and modify the standard language as needed.

18. DISAdvantages of Development by “government” sponsored standards organizations. 1. Would require establishment of a “Standards Board” with funding and authority. 2. Few other problems exist.

19. RECOMMENDED PLAN Government Agency be set up to Establish & Maintain Standard Electronic Data Dictionary which would be “free” for public use.

20. Strategy #1 Responsible Government Agency take on the task by themselves with oversight of a “public expert Board”

21. Strategy #2 Responsible Government Agency CONTRACT with a private organization or firm to do the task. Also with oversight of a “public expert Board.”

22. Reed M. Gardner, PhD Professor & Chair of Medical Informatics University of Utah AB193 School of Medicine University of Utah 50 North Medical Drive Salt Lake City, UT 84132 801 585-9428 FAX 801 581-4297 Reed.Gardner@hsc.utah.edu 22