Medical Record Database Efficient but Troubling

Imagine being able to retrieve a patient’s electronic medical record that has been updated by every health care professional the patient visits. This scenario isn’t science fiction and will raise more questions about whether the federal privacy rules sufficiently safeguard individual health information.

Last month the federal government announced two health information initiatives designed to build a unified electronic medical records system in the United States.

Health and Human Services (HHS) Secretary Tommy Thompson announced that HHS and the departments of Defense and Veterans Affairs (VA) will incorporate a common clinical terminology into their information systems to facilitate the exchange of health care information electronically.

The federal agencies will use SNOMED-CT, which stands for the Systemized Nomenclature of Medicine–Clinical Terms, owned by the College of American Pathologists (CAP). The HHS, VA, and Defense departments are subsidizing the $32.4-million license that the National Library of Medicine (NLM) purchased from the College of American Pathologists for use of SNOMED-CT.

NLM, which is part of the National Institutes of Health, will incorporate the core content of SNOMED-CT in English and Spanish into its Unified Medical Language System (UMLS). The UMLS contains more than 100 biomedical and health vocabularies and classifications that are linked and distributed in a common format, according to UMLS advisor Carolyn Tilley of NLM’s Bibliographic Services Division.

The UMLS contains DSM-III and DSM-IV, the ninth and 10th editions of the International Classification of Diseases (ICD), and the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction code sets, Tilley told Psychiatric News.

SNOMED-CT will be accessible through the UMLS database early next year, said Tilley. “We anticipate that SNOMED data will be incorporated into information systems in hospitals and other health care institutions used by health care professionals,” said Tilley.

While HHS plans to incorporate privacy protections mandated by the HIPAA regulations into the new electronic health care system, APA’s immediate past president, Paul Appelbaum, M.D., expressed concern about breaches of confidentiality and the HIPAA regulations themselves.

“Greater ease of access to electronic medical records is a double-edged sword,” he told Psychiatric News. “Although patient care can be improved by accurate data, if information ends up in the wrong hands, jobs can be lost, insurance denied, mortgages refused, and personal relationships altered.”

Appelbaum continued, “Perhaps news of the government’s plans for what essentially will be a national data bank of personal medical information will stimulate a closer look at the misguided HIPAA privacy regulations. As currently framed, they would allow—indeed facilitate—the uncontrolled sharing of large amounts of electronic patient data, a frightening prospect to anyone who recognizes that privacy is critical to high-quality medical care.”

In a complementary initiative, Thompson commissioned the Institute of Medicine (IOM) to develop a standard model electronic medical record (EMR) to be ready some time next year. Ultimately, the goal is to integrate the EMR with SNOMED-CT, according to the press release.

HHS is encouraging and facilitating the widespread use of modern information technology to improve the nation’s health care system, said Thompson in the press release.

“Adopting a common clinical terminology and codes will simplify health care communication with the government and ultimately benefit the public,” John Goethe, M.D., told Psychiatric News. He is the director of the Burlingame Center for Psychiatric Research and Education of the Institute of Living in Hartford, Conn.

Thompson said, “This unified EMR system will prove invaluable in facilitating the automated exchange of clinical information needed to protect patient safety, detect emerging public health threats, better coordinate patient care, and compile research data for patients participating in clinical trials.”

Diane Aschman, chief operating officer for SNOMED International, told Psychiatric News, “The beauty of SNOMED-CT is that it is designed to index medical record information across medical specialties and sites including signs and symptoms, diagnoses, and procedures. The clinical terms are encoded in a computerized format, which facilitates data gathering for many purposes including public health surveillance and research.”

NLM chose SNOMED-CT for use by both the federal and private sectors because studies have shown that it is the most comprehensive and widely used medical vocabulary in the world, said Aschman. At least 40 countries including the United Kingdom and small health care businesses in the United States have adopted SNOMED-CT, according to Aschman.

SNOMED evolved from a reference terminology for pathologists in the 1960s into a comprehensive clinical terminology through CAP’s collaborative efforts with primary care physicians, nurses, and other allied health care professionals. Several medical specialty vocabularies, including ones for mental health, have been incorporated into SNOMED-CT, explained Aschman.

Several groups including the IOM and the National Committee on Vital and Health Statistics (NCVHS) have recommended in reports and studies that the federal government adopt a common health care language and subsidize the maintenance and distribution costs.

Agencies within HHS that helped fund the NLM license to use SNOMED-CT include the Centers for Disease Control and Prevention, National Institutes of Health, and the Substance Abuse and Mental Health Services Administration, according to the NLM statement. HHS is also coordinating its efforts to standardize health information with other health agencies as part of the Consolidated Health Informatics Initiative, a health care component of President Bush’s eGov Initiatives, according to a SNOMED International press release.

To protect confidential patient information, SNOMED-CT uses codes rather than text to represent clinical terms, said Aschman. HHS spokesperson Bill Hall said the unified electronic medical records system will be developed in compliance with HIPAA requirements.

HHS also announced last month that it will establish a new health care technology council. Its initial focus will be on creating incentives for health care organizations to adopt a standard medical terminology such as SNOMED-CT, electronic medical records, and other government standards, according to the July 2 iHealth Beat.

Fact sheets on UMLS/SNOMED are posted on the Web at www.nlm.nih.gov/research/umls/Snomed/snomed_faq.html. ▪