Are regulations stalling the future of health technology?
Technology promises to transform health care, whether through mobile applications, wearable trackers or electronic health records. Still, it’s clear that this hasn’t yet happened, so what’s wrong with the system?
Perhaps nothing, except that it’s just slowly getting to where it should be. “I would caution against us making any final conclusions of overall value or potential of health information technology (HIT) at this vantage point; it would be similar to looking at the fate of Friendster and making a final determination on the future success of something like Facebook,” said Cason Schmit, JD, research assistant professor at the Texas A&M School of Public Health. “There is so much more room for growth.”
And just like Facebook, most of the real utility—and economic potential—of HIT will be realized when all of the systems come together in an interconnected network that is used by a critical mass of people. “By themselves, separate HIT systems are not going to have much of an impact,” Schmit said. However, if electronic health records of thousands or even millions of patients link together in a massive health information exchange (HIE) and combined with other auxiliary technology like electronic drug prescribing, there might be a synergistic effect.
For example, a health information exchange allows health care providers in different practices or even in different regions to access the health history of the patient in front of them. Still, it only works if many providers have all opted into the same network. “By its nature, a HIE is a valueless system on day one; HIE needs users and patient data,” Schmit said. “You need to build it up to the point where it is worth a physician’s time to look up their patient on the HIE.”
Once it has been built up, though, it could be of real benefit. Care of the patient can be integrated, with providers being alerted of potential drug interactions and notified when their patients visit the emergency department. Evidence suggests it can also cut down on the cost of imaging and diagnostic tests if providers had easy access to earlier scans—and didn’t have to repeat them. Medical errors—18 percent or more of which can be attributed to an information gap, according to studies—might also be reduced.
However, even with all of these benefits, technological change won’t happen overnight. “It’s difficult to get there because, among other administrative and technical challenges, there are many real and perceived legal barriers that stand in the way of achieving high-value use cases,” Schmit said. “There are legacy legal frameworks that apply to traditional health care practice that are not facilitating the free exchange of health information required for some advanced HIT uses.”
The trouble is that there are literally thousands of laws—many of them well-intentioned attempts to protect patient privacy—getting in the way of this free exchange of information.
“There are 2364 state statutes and regulations relating to electronic health information as of 2013,” Schmit said. “I counted.” That’s not to necessarily say that each of those laws is in itself an insurmountable barrier, but the sheer number of laws can make some people less inclined to try something new for fear of running afoul of one of the laws. “We are working with a technology that is evolving incredibly quickly and a massive regulatory framework across 50 states that is moving very, very slowly,” he added. “It is very difficult for innovators of emergent technologies to create something that can be applied nationwide and that will be compliant.”
“These existing real and perceived legal and policy barriers need to be addressed so we can actually go where we need to go,” Schmit added. “It’s clear that in our current health care system, we’re not there yet.”