Paging Dr. IT

While it may not make the front page, a quiet breakthrough in information technology (IT) is taking place that will not only save lives but also improve the overall state of health care in the U.S.and the world. IT is becoming widely available at the doctor’s office, hospital, and in-home care settings. As this technology gains ground, the benefits to both medical institutions and their patients will be substantial and immediate which is why IT for health care has become a major area of focus for CITRIS.

“The most pressing societal problem our nation faces is health care. It is the fastest-growing sector of the economy, yet we are not getting the best quality of health care for those expenditures. It is clear, in terms of societal-scale problems, that we need to pull together the best technology to improve health care,” explains CITRIS Director Shankar Sastry.

Take medical errors. As many as 98,000 Americans die in hospitals each year from preventable blunders, such as being given the wrong drug or dosage, according to an oft-cited report from the National Academy of Sciences’ Institute of Medicine. The problem caught the attention of Presidents Clinton and Bush, both of whom put forward plans to fix the situation. A key part of Bush’s proposal, announced in his 2004 State of the Union Address, is providing most Americans with electronic medical records (EMRs) within the next 10 years. It is believed that EMRs would eliminate common mistakes, such as misread handwriting, and ensure that when a patient is admitted to the ER, his complete medical history, including drug allergies and current prescriptions, would arrive with him.

Topping the list of challenges to instituting Bush’s plan are the twin issues of privacy and security. No one wants private medical information to fall into the wrong hands or be mismanaged. To address the issue, CITRIS’s Team for Research in Ubiquitous Secure Technology(TRUST) held a meeting on EMRs at UC Berkeley in April. Among the speakers were Lori Hack, acting CEO of The California Regional Health Information Organization, which is coordinating a health information exchange system in the state, and Dr. David Brailer, the former National Coordinator for Health Information Technology. TRUST researchers are working closely with these organizations and other stakeholders to ensure that California’s system and will be trustworthy in every way.

In addition to reducing medical errors, EMRs are also expected to slow rising health care costs. In 2004, Americans spent $1.6 trillion on health care, 16 percent of the Gross Domestic Product (GDP). By 2015, that number is projected to rise to $4 trillion, 20 percent of the GDP. Much of that money, more than 30 percent according to a study published in the New England Journal of Medicine, is going towards administrative costs. Whereas IT has streamlined the banking, transportation, and retail sectors, to name a few, most healthcare providers are still operating in the 19th century when it comes to administrative tasks, including the transportation of patient records and lab results. Yet, medical professionals have been slow to modernize.

Professor Stephen Shortell, Dean of UC Berkeley’s School of Public Health

“Currently, only about 20 percent of physician office practices have any kind of electronic health functionality,” says Dr. Stephen Shortell, Dean of UC Berkeley’s School of Public Health.

Shortell and his colleagues have been educating CITRIS researchers and collaborators on the obstacles preventing more hospitals and physician practices from adopting IT. One of the biggest obstacles to conversion is the cost. Many doctors feel they simply cannot afford the time and money it would take to convert a paper-based office into a digital one, according to Shortell. In addition, doctors are used to working autonomously and tend to bristle at the notion of any part of their work being automated. Plus, health care is more complex than many sectors that have already embraced IT.

“It is a lot easier to automate ATM machines and online banking than it is to transfer electronic health records. You have even bigger privacy concerns. Plus, you are dealing with people whose conditions change from minute to minute,” Shortell says.

At the same time, doctors do realize that with new medical studies being published daily, keeping up with the latest information is no longer possible without help. For that reason, Shortell believes that some IT tools will catch on, such as smart reminders that would automatically point doctors from a patient’s electronic health record to information on her known drug reactions and relevant studies. In the meantime, to encourage doctors to adopt IT, Shortell recommends technical support and financial incentives, ranging from low-interest loans and outright grants.

It is a transition that is increasingly necessary. Europe and America’s population is aging, in large part due to high-quality healthcare and living conditions. According to a U.S. Health and Human Services report 70 percent of the world’s elderly population will reside in developed countries by 2030. Clearly, a more sophisticated and robust health-care system than the one we have today is needed to meet this growing demand.

To that end, CITRIS is initiating several research projects focused specifically on health care for people over the age of 65. Led by CITRIS’s founding director Ruzena Bajscy, the Elder Tech initiative is examining how to use the latest IT tools, such as sensor networks and real-time embedded software systems’ to improve the lives and care of the elderly. For example, the Elder Tech project Information Technology for Assisted Living at Home (ITALH) will enable elderly people to live safely at home for longer.

“Falls are one of the biggest concerns that elderly people have about living at home on their own. They are afraid they will not be able to get in contact with anybody to help them if they fall down and get hurt. Almost all the elderly people we talked to know someone towhom this has happened,” says by Dr. Mike Eklund (EECS), who headed ITALH until this fall.

Started by CITRIS, ITALH is working with researchers at the Alexandra Institute in Aarhus, Denmark, and Tampere University of Technology in Tampere, Finland, to create and test a system of sensor networks that will automatically alert emergency workers via a cellphone when a person falls. With proper security and privacy precautions, Eklund predicts the data gathered by these types of sensor networks, including heart rate and blood sugar, could be made available to doctors for everything from diagnostics to research.

In addition to running ITALH, Eklund organized a series of three conferences on Health Information and Communication Technology. Sponsored by CITRIS, Connections I, Connections II, and Connections III, held on August 11, brought together researchers from around the world to discuss and plan how to develop IT to improve health care. While the series has come to an end, Shortell points out that these efforts are just the beginning: “I think it is great that CITRIS is staking out the health sector as one of its areas for work and doing that collaboratively with the School of Public Health and the Center for Health Research here at Berkeley. It is going to be a continued growth area and area of interest as far as future funding, too.”