Better data could mean better care

 Electronic health records could become a component of health care quality improvement, but the idea raises fears that too much quality information could lead to declines in care as doctors try to improve their performance by avoiding the sickest patients.

Medical organizations could collect, analyze and transmit data to providers and patients to help them make care decisions in a feedback loop called a “learning health care infrastructure,” said Dr. David Blumenthal, national coordinator for health IT at the Health and Human Services Department. Speaking at a Brookings Institution forum on health quality Dec. 2, Blumenthal said the adoption of electronic health record systems is a steppingstone toward that goal.

For example, medical professionals are collecting data on people who received the swine flu vaccine to determine whether the vaccine is as safe as previous vaccines. In the future, doctors treating people with asthma, heart disease and diabetes could receive up-to-date data on whether the latest treatments are working. That kind of data on quality could allow health care providers to pinpoint weaknesses and improve them.

But the Journal of the American Medical Association worries that easily accessible data could cause problems, especially if it's made public. For example, some doctors might seek healthier patients to avoid poor outcomes.

“There will always be concerns about unintentional consequences,” said Dr. David Kibbe, a health care consultant.

Blumenthal said bringing the vision to fruition will be a long-term effort. “The vision is there, and the path is beginning to be conceived,” Blumenthal said. However, he added, it could be a long path because no global organization is collecting and using health data for quality goals in this manner. For now, the immediate aim is to get the digitization started, he said.

“By the end of 2009, we need a regulation for electronic health records,” Blumenthal said. “It all starts with a robust electronic infrastructure.”