By Tom Ventsias

It's been 15 years since University of Maryland researchers invented the technology to allow doctors to get a compact overview of patients' information-office visits, hospitalizations, medications and lab results-on a single computer screen.

But today, only 8 percent of the nation's 5,000 hospitals and 17 percent of its 800,000 physicians are using computerized record-keeping systems. The federal government is racing to meet its self-imposed deadline of digitizing all Americans' health records by 2014.

"Changing the way medical professionals work is not easy … and turning an academic idea into a commercial success is sometimes a long and difficult process," says computer science Professor Ben Shneiderman, who with senior research scientist Catherine Plaisant guided the research efforts to modernize medical records.

The problem has taken on new urgency with $19 billion of this year's economic stimulus earmarked for bringing the nation's health-care records into the digital age. The president and Congress continued to debate health-care reform into the fall, with the president stopping on campus in September to hold a reform rally.

The solution lies with the use of health information technology, or health IT, which can expand health-care access, improve quality, prevent medical errors and reduce costs.

Maryland faculty are already leaders in this field, creating software that can spot trends in patients' medical histories, developing tools to train senior citizens in online "health literacy" and studying the financial impact of improved communication in hospitals.

It seems like it should be a no-brainer for all the stakeholders in health care to embrace information technology, says Ritu Agarwal, the Robert H. Smith Dean's Chair of Information Systems. After all, it's been more than two decades since the U.S. banking industry discovered that electronic banking could greatly speed up transactions, reduce errors and attract customers.

President Obama visits Maryland for a health-care rally. Photo by John T. Consoli

But Agarwal says significant hurdles-besides the cost, estimated at as much as $150 billion—are holding up the revolution in health IT: Insurance companies may not believe it's in their best interest to empower consumers. Hospitals are reluctant to invest in expensive health information technology if doctors aren't going to use it. And consumers have a number of serious concerns—from a digital health record provider going out of business (taking hundreds of medical records with it), to the fear of unauthorized users accessing their personal health information.

"There isn't any rigorous evaluation of what the benefits of using these technologies are, so people are reluctant to make [large-scale] investments of both time and money," says Agarwal, founder and director of the Smith School of Business's Center for Health Information and Decision Systems, or CHIDS.

That's where her work comes in. In one study, Agarwal is evaluating how the use of electronic prescribing-which allows a doctor to write a prescription on a computer notepad and send it directly to your pharmacy—can change the workflow in small physician practices.

Researchers in CHIDS are also at Children's National Medical Center in Washington, D.C., determining whether its new IT system for inputting and tracking physician's notes has affected the way attending physicians and consultants do their rounds, especially doctors who are attending to patients with complex illnesses and injuries.

U.S. hospitals waste about $12 billion a year because of communication inefficiencies, according to some estimates, but Agarwal says it's important to build a model to quantify the actual cost.

Taking Charge of Your Health

Bringing health-care records into the digital age could give patients better access to their records and the ability to make more informed choices.

Dr. Sidney Wolfe, acting president of the consumer advocacy group Public Citizen, says it is essential for people to have unfettered access to their personal health records—as well as a basic understanding of what those documents represent.

He says patients who can review their records might discover a documenting error that could have serious consequences down the road, such as being denied life insurance or health insurance. The digitizing of health records also allows consumers an awareness of test results or consultations that doctors should generally be telling patients about, but sometimes don't, he adds.

"The more a patient knows about their own diagnosis and treatment, the better they can participate in their own health care," Wolfe says. Making informed health-care decisions, however, first requires sufficient health literacy, or the ability to obtain and understand basic health information and services.

Research in the College of Information Studies, Maryland's iSchool, is helping seniors—who are more prone to medical problems yet less likely to be computer-savvy—improve their health literacy and learn the basics of accessing health information online.

Twice a week, iSchool graduate students meet at a Prince George's County library with small groups of predominantly African-American women over the age of 60. These adults are taught how to distinguish valid health information from online advertising and also learn computer skills like how to navigate the Internet or use a mouse.

Funded by the National Library of Medicine, the project is led by Assistant Professor Bo Xie, whose goal is to improve training techniques that boost health literacy. "For this age group, we have discovered that people pick up the knowledge faster if they are working together with their peers. That collaborative learning is very important," Xie says.

In the university's School of Public Health, faculty are also involved with improving health literacy—especially for underserved groups—as well as studying demographic factors that influence the effectiveness of online health information.

Nancy Atkinson, director of the school's Public Health Informatics Research Laboratory, specializes in developing health IT education programs.

While social media tools like Facebook and Twitter are popular with support groups for weight loss or other health issues, she says consumers need to learn how to evaluate the quality and validity of health information they are getting online.

Atkinson says reliable online health tools can help people make decisions in a safe environment and teach them about health in an engaging way. "You can't force people to sit down and listen to a lecture, but if you can give them an online health-risk assessment that has interactive features, there is a much better chance of the person participating in making informed decisions about their health care," she says.

One example might be an online shopping game in which people could practice buying food, then get feedback on the nutritional benefits of items they purchase. After playing a similar game aimed at children, Atkinson says, young research subjects then told their parents: "I need to eat more breakfast!"

New Health IT Tools

For health IT to really blossom, says Ben Shneiderman, doctors need to get on board. "The key word for medical professionals is interoperability," he says. "They are interested in helping people get better, not having to learn two or three new computer systems."

Working with colleagues in the university's Institute for Advanced Computer Studies, Shneiderman has designed a new computer interface called Lifelines2 that is compatible with almost any existing health IT system. The technology gives physicians an overview of the patient's history-up to 100 years or 10,000 medical events-and it lets doctors pull up groups of patient histories to see any emerging health patterns.

This feature can help in busy emergency departments, says Dr. Greg Marchand, senior attending physician of emergency services at Washington Hospital Center. "We can run blood work and immediately see if it matches certain patterns of irregularities in other patients we've admitted," Marchand says. "This technology saves time and gives us another important diagnostic tool."

Marchand is part of a group of physicians at the hospital testing the Lifelines2 technology.

"In its most basic form, medicine is people helping people," he says, "Still, these new technologies will not only make for better care by doctors, but also help patients make healthier choices on their own." TERP

Click here to view a video showcasing Lifelines2 technology.

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