Reflections on the history of interoperability in hospitals.

Objective: To discuss the origins of HL7 and its subsequent impact on interoperability in hospitals.

Process: Reconstruction of historical events from review of personal notes, interviews with key participants and review of relevant publications.

Conclusions: The first versions of HL7 were based on the StatLAN protocol developed at the University of California, San Francisco and later commercialized by Simborg Systems Corporation.

The wave has finally broken: now what?

In 2005, the authors published a paper, 'Will the wave finally break? A brief view of the adoption of electronic medical records in the United States', which predicted that rapid adoption of electronic health records (EHR) would occur in the next 5 years given appropriate incentives. The wave has finally broken with the stimulus of the health information technology for economic and clinical health legislation in 2009, and there have been both positive and negative developments in the ensuing years. The positive developments, among others described, are increased adoption of EHR, the emergence of a national network infrastructure and the recognition of clinical informatics as a medical specialty.

There is no neutral position on fraud!

In 2005, Dr David Brailer, our first National Coordinator for Health Information Technology, had a vision of widespread adoption of electronic health records connected through networks run by regional health-information organizations. An advisory panel recommended at that time that proactive fraud management functions be embedded in this emerging information infrastructure. This has not occurred.

Consumer empowerment versus consumer populism in healthcare IT.

Institutions, providers, and informaticians now encourage healthcare consumers to take greater control of their own healthcare needs through improved health and wellness activities, internet-based education and support groups, and personal health records. The author believes that "untethering" all of these activities from provider-based record systems has introduced a form of unhealthy consumer populism. Conversely, integrating these activities in a coordinated manner can sustain both consumer empowerment and consumer well-being.

Crime and punishment. Can the NHIN reduce the cost of healthcare fraud?

In his 2004 State of the Union Address, President Bush called for the adoption of the electronic health record (EHR) to increase efficiency and improve the quality of healthcare. This system could reduce healthcare costs by 20 percent or more per year. Some of those savings would be attributed to a dramatic reduction in losses due to fraud.

Will the wave finally break? A brief view of the adoption of electronic medical records in the United States.

For over thirty years, there have been predictions that the widespread clinical use of computers was imminent. Yet the "wave" has never broken. In this article, two broad time periods are examined: the 1960's to the 1980's and the 1980's to the present.

More than medicine. Interview by Chris Serb.

For all the business savvy demanded by their work as hospital CEO, info tech chief, or entrepreneur, these doctors say it's their medical background that gives them an edge. They know the needs and routines of physicians firsthand. They come to their jobs with built-in credibility as clinicians.

The federal role in the health information infrastructure: a debate of the pros and cons of government intervention.

Some observers feel that the federal government should play a more active leadership role in educating the medical community and in coordinating and encouraging a more rapid and effective implementation of clinically relevant applications of wide-area networking. Other people argue that the private sector is recognizing the importance of these issues and will, when the market demands it, adopt and enhance the telecommunications systems that are needed to produce effective uses of the National Information Infrastructure (NII) by the healthcare community. This debate identifies five areas for possible government involvement: convening groups for the development of standards; providing funding for research and development; ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; protecting rights of privacy, intellectual property, and security; and overcoming the jurisdictional barriers to cooperation, particularly when states offer conflicting regulations.

Information industry leaders share visions of future. Interview by Carolyn Dunbar and Michael L. Laughlin.

Computers in Healthcare editors Carolyn Dunbar and Michael L. Laughlin spoke to nearly a hundred exhibitors during the 1992 Healthcare Information and Management Systems Society last February in Tampa, Fla. The themes of these conversations invariably turned to patient-focused systems, standards, integration and, of course, controlling healthcare costs.

Riding the right horse. Interview by Eric Skjei.

To date, 14 hospitals have decided to install a "systems integration product that adds value to a network technology." According to its progenitor, the product also maximizes the flexibility of departments in choosing the right product for their specific needs. CIH talked with Dr.

The case for the HL7 standard.

An effort begun in the spring of 1987 by a group of executives within the healthcare industry to establish a Level 7 networking standard (HL7) is rapidly gaining momentum. This article discusses a draft Level 7 protocol which has been produced to ease the complications inherent in the multi-vendor environment of healthcare communications.

A computerized summary medical record system can provide more information than the standard medical record.

We assessed the ability of a computerized outpatient medical record (MR) system, the Summary Time-Oriented Record (STOR), to communicate information to clinicians in two randomized single-blind studies. In the first study, physicians were better able to predict their patients' future symptom changes and laboratory test results from outpatient visits to an arthritis clinic when STOR was added to the standard MR than when the standard MR was used alone. In a separate study, the removal of the standard MR did not result in important decrease in the physicians' ability to predict their patients' symptoms and laboratory test results if they had the option of using the full paper record when they thought they needed it.

Classification of ambulatory care using patient-based, time-oriented indexes.

This paper presents a new approach to the classification of ambulatory care into isoresource consumption groups. In contrast to classification schemes based on visits, this case-mix approach creates an index based on resources used by diagnostic categories by a patient during a year. An application of this method to a primary care, group practice data base produced resource consumption groups with coefficients of variation in an acceptable range compared with the coefficients of variation of the diagnosis-related groups used to classify inpatient care.

Choosing the correct unit of analysis in Medical Care experiments.

The statistical methodology of health research experiments published in Lancet, the New England Journal of Medicine, and Medical Care between 1975 and 1980 for the presence or absence of an error of experimental design and analysis was examined. The error is the result of inappropriately using patient-related observations as the unit of analysis to form conclusions about provider behavior or outcomes determined jointly by patients and providers. The error was present in 20 of 28 (71%) health care experiments addressing an issue of health provider professional performance.

The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital.

To test the hypothesis that physician education is an effective strategy to reduce total hospital costs, we evaluated three educational interventions at a large university hospital. This prospective controlled study spanned two academic years and involved 1,663 patients and 226 house staff. In the first year, weekly lectures on cost containment (medicine and surgery) and audit with feedback (medicine only) both failed to produce a significant change in total hospital charges.