As the chairman of the national Healthcare Information Technology Standards Panel (HITSP), Halamka has been at the forefront of efforts to make ubiquitous access to health-care data a reality. In a preview of his keynote speech, Halamka said that over the past two years, HITSP has created standards for identifying, transmitting, accessing and safeguarding medical data.
"How useful would the Web be if we needed a different browser for every site?" he asked rhetorically.Advocate for open access
To date, the panel has completed data standardization for labs, medications, allergies and personal health records and continues to develop secure communication standards for transmitting medical information from home-based diagnostic devices to medical facilities, he said. The panel is also at work on challenges like transmitting genomic biomarkers in a standards-based way to ensure the accuracy of personalized prescription drug doses, he said.
Halamka said that over the next five years genome sequencing should become widely available. The process is still in its early stages, and in fact, Halamka is the fourth person to have his genomic makeup fully sequenced. The goal driving medical data standardization is the creation of genomic, Web-based health records of every patient that are available over the course of a lifetime. With this information readily available, the medical community will be able to deliver personalized care, he said.
Google Inc. and Microsoft have already incorporated the panel's data standards and created Web portals for personal health information; Google Health is a public site and Microsoft Health is for Microsoft employees. The Cleveland Clinic and Blue Cross/Blue Shield of Massachusetts are already linked to the Google site.
In terms of electronically generated prescriptions, Massachusetts is the No. 1 state in the nation, and it had 100 million electronic medical record transactions between doctors, hospitals and insurance companies in a year, Halamka added. Since 2001, Beth Israel Deaconess hasn't issued handwritten medical orders, he said.
"There is still a lot of work to do, but this is getting real," Halamka said. "We are really at the tipping point" of national, standards-based, portable medical data retention and transmission, he said. Now the challenge is how to provision IT departments to implement all this in an interoperable way, he said.
And Halamka asserted that IT professionals in all industries should take interest in the efforts to standardize data communication in the medical field, because "standards work is occurring in all industries," he said.
Over the past two years, in addition to promoting conversion to electronic records at Beth Israel Deaconess, Halamka has replaced all the old Unix servers with Red Hat Enterprise Linux clusters running on commodity hardware. Collectively, the 150 physical servers and 250 virtual servers store a half-petabyte of mission-critical data on cheaper, off-the-shelf machines and achieve higher throughput with lower power consumption, he said.
"Rather than one giant system, we use smaller servers and manage the power and cooling requirements of every device," Halamka said. "The goal is to keep the data center under 200 kW."Cool under pressure
Halamka also discussed how his background as an emergency room professor at Harvard Medical School has benefited him in his role as a CIO.
Both jobs typically attract those who are impatient, quick to prioritize and comfortable taking risks, he noted. Like ER physicians, CIOs often have to make choices based on incomplete information, he said.
During his worst IT crisis, an electrical utility engineer working on construction across the street unplugged New England Deaconess' generators, bringing the data center to a grinding halt, he said. The sudden shutdown took its toll on equipment, but as a result, the hospital's IT staff became experts in power management, redundancy and navigating relationships with contractors to prevent such situations in the future, he said.
In 2002, Halamka also faced a crippling power reduction at Beth Israel, whose mystifying data slowdown forced the hospital to revert briefly to paper records. Lasting a day and a half, the crisis then took nearly a week to diagnose and fix. The culprit was its outdated, Libby030 switch-based network, which lacked exterior and interior safeguards of the Cisco 6509 routers that were chosen to replace them.
"We had challenges transitioning to paper and later restoring the data and workflow," he said. "Instead of panic, we approached the crisis in an open, transparent way and shared the lessons we learned."
To win physicians' support for electronic systems whose cumulative statistics force them to be more accountable, Halamka enlisted staff as partners rather than order an IT solution from above.
"Imposing orders is a setup for failure," he said. "We had the doctors themselves design a system that creates order sets with one click and ensures that best practices just happen. This, in turn, gives them higher-quality practices and higher scores on performance."
As for winning management support for electronic records, Halamka said he stayed focused on his work "in the trenches" while governance committees engaged stakeholders, who in turn promoted the change in the interest of quality care and positive medical outcomes.That's not to say that hospitals will achieve all-electronic record-keeping or total data security. "A paperless hospital is as likely as a paperless bathroom," Halamka said. Ditto for the nirvana of absolute security. "Software vendors do overpromise," he conceded. "But the key is to pick mature technologies and implement in steps. You follow a trajectory [of automation and integration], and it gets better and better."