# Presentation: 007651

## National Committee on Vital & Health Statistics

**National Committee on Vital & Health Statistics**

- Testimony of
**Reed M. Gardner, PhD** Professor 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

## KNOWLEDGE

- DATABASE

- DECISION
- MAKING
- PROCESSOR,
- DATA AND
- TIME DRIVER

- Data Review
- Alerts
- Computations
- Interpretations
- Protocols

- OUTPUT

- INTEGRATED
- CLINICAL
- DATA
- BASE

- ICU/SURGERY

- Ventilators

- Pulse
- Oximeters

- IV Pumps

- Mixed Venous
- Saturations

- MIB
- Data

- ECG
- Lab

- Pharmacy

- Infectious
- Disease

- Nurse
- Care
- Plans

- Transcribed
- Dictation

- Nursing
- Procedure
- Charting

- Bedside
- Monitors

- Physiologic
- Data

- Surgery &
- Anesthesia
- Charting

- Laboratory

- Pathology

- Blood
- Bank

- Catherization

- Respiratory
- Therapy

- Admitting

- Medical
- Records

- Surgery
- Schedule

- Blood
- Gas Lab

- X-Ray

## Slide 3

## Computer-Assisted Antibiotic ManagementAnn Intern Med 1996; 124:884-890

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

## “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

- 			*Clement J. McDonald, MD*
*	**	**	**June 1994*

## #1Multiple sourcesof the sameinformationproduce differentvalues. 10 Potholes in the Road to Information QualityAdapted from Strong, Yang, and WangIEEE Computer August 1997, 30:(8)38-46.

**#1****Multiple sources****of the same****information****produce different****values. **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.*

## #2

**#2**
**Information is**
**produced using**
**subjective**
**judgments,**
**leading to bias.**

*Example:  When medical coders use their  independent judgment to select disease codes.*

## #5Distributedheterogeneoussystems lead toinconsistentdefinitions,formats, andvalues.

**#5****Distributed****heterogeneous****systems lead to****inconsistent****definitions,****formats, and****values.**

*Example:  Different systems in each division, each using a different format for diagnostic codes.*

## #8As informationconsumers’ tasks andthe organizationalenvironment change,the information thatis relevant anduseful changes.

**#8****As information****consumers’ tasks and****the organizational****environment change,****the information that****is relevant and****useful changes.**

*Example:  The basis for insurance reimbursement to hospitals changes (capitation of care), requiring changes in information processes and systems.*

## “Adaptation” of 

**“**_**Adaptation”**_** of **
**Genesis 11:1-7**
**Tower of Babel**

- Go to, let us go down, and there _UN_confound their language, that they may not understand one another’s speech.

## “Adaptation” of 

**“**_**Adaptation”**_** of **
**Genesis 11:1-7**
**Tower of Babel**

- And the whole earth was of one language, and of one speech.

## What does the HIPAA Legislation Call for?

**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!

## How should such 

**How should such **
**“****standardized language” be established?**

- Two possibilities:
- 1.  Development by “private” 				standards organizations.
- 2.  Development by “government” 		sponsored standards organizations.

## Advantages of

**Advantages of**
- Development by “private” standards organizations.

- 1.  A currently existing methodology.
- 2.  Concensus methodology used.

## DISAdvantages of

**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.

## Advantages of

**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.

## DISAdvantages of

**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.

## RECOMMENDED 

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

## Strategy #1

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

## Strategy #2

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

## 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

- 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