Components of HIT…a start

Health information technology (HIT) is a broad and extremely complex field, and I want to visualize it. I’m going to need your help to do it. But first it needs defining…

HIT could simply be defined as any information technology utilized within the healthcare industry vertical, but that would be too inclusive, because that means a MySQL database is considered HIT because it is sometimes used in a hospital. Brailer & Thompson, former ONC Secretary and former HHS Secretary respectively, define it as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Thompson & Braile, 2004). The line between HIT and health informatics is fuzzy and we’ll ignore it for now.

With this definition, I tried to create a hierarchical list of the types of health IT software. I want the list to be comprehensive in breadth and don’t care quite as much about depth (3 or 4 levels should be sufficient). There are dozens of ways to structure this list and probably hundreds of items I missed. This is a work in progress, so please leave a comment and let me know what you would change/add/remove. I’ll keep updating it until everyone feels good about it. After that comes the visualization…

HIT Categorization Hierarchy – Take 5

• Clinical
  • EMR/EHR
    • Ambulatory
    • Specialty
    • Anti-Retroviral Treatment (ART) Focused (common in areas with high HIV/AIDS & TB prevalence)
  • eRx (CPOE)
  • Clinical Decision Support
  • Digital Imaging & Archiving Systems (e.g. PACS)
  • Medical Devices & Equipment
  • Clinical Document Management
  • “Personalized Medicine”
• Hospital/Clinic Management
  • Physician Office Management Information System (POMIS)
  • Hospital Management Information System (HMIS)
  • Accounting
  • Patient Billing
  • Claims Processing
  • Human Resource Management
  • OR Scheduling
  • Appointment Scheduling
  • Lab/Pharmacy Management
• Public Health & Biosurveillance
  • Public Health Reporting
  • Diesease Surveillance Networks (e.g. CDC Biomonitoring and Environmental Public Health Tracking Network)
  • Vital Registry (Birth, Death, & Marraige Records)
• Consumer-Oriented Technologies
  • Personal Health Devices (e.g. WAN-enabled weight scale, phone-enabled glucose monitor, etc.)
  • Personal Health Applications (i.e. exercise & weight tracking)
  • Patient Portals
  • Personal Health Records (PHR)
  • Health-centered Social Networks (Patients Like Me, 23andme, etc.)
• Medical References
  • Drug references (for docs and patients)
  • Medical references (like WebMD, also for docs and patients)
• Research
  • Genomics
  • Medical data warehousing
  • Clinical Trial Recruitment, Management, etc.
• Regional & Systems Level Health Information Systems
  • Vitals Registration
  • Health Information Exchange (HIE)
  • National Health Information Network (NHIN)

A special thanks to the Twitterers that have already helped me on this: @chadosgood, @oneofthefreds, @ChristineKraft, @ePatientDave, @MedC2, and my good friend Jake. And a shout out to Sam Adam’s HIT Primer on his blog, IT (R)EVOLUTION, that helped get me started.

A few other helpful sources:

• Thompson & Braile, 2004
• Wikipedia: List of open source healthcare software
• Meaningful Use Matrix

US Behind in HIT Spending – Stimulus Insufficient

Despite the fact that the US spends nearly twice as much on healthcare as any other country, the US is as much as 12 years behind other OECD countries in health information technology investment. See the Commonwealth Fund’s entry on Health Care Spending and Use of Information Technology in OECD Countries.

The American Recovery & Reinvestment Act of 2009–the Stimulus Package–apportions $19 billion for investment into the HIT infrastructure in the US. As much as $3 billion goes to the Office of the National Coordinator (which will now be codified) and other standards creating bodies. The remaining amount will be given to providers primarily through increased Medicare reimbursement. If divided evenly, each hospital would receive approximately $11 million. A substantial sum, but hardly close to the $200 million over 3 years required in a typical implementation at a 300+ bed hospital. Only 10% of hospitals currently have full electronic health records. Another 20-30% are in planning or implementation stages. The stimulus may encourage more providers to enter the planning stages and will help along those already in the process during difficult economic times. But $11 million for the remaining 60-70% is entirely insufficient.

Evidence shows that the only providers that stand to get a return on investment in HIT are large network providers with geographically distributed practices, such as Kaiser or the VA. This makes sense, as the administrative cost of sharing information is high. The early adopters (the 10%) consist of these large networks and a few providers with well-funded, forward-thinking CIOs. The 20-30% currently planning hope to break even at best and justify the investment by improved patient care (especially through CPOE). The rest are mostly too small to realize significant cost savings and will likely need much more than $11 million to break even.