The Next Frontier in Health Care Reform

May 7, 2010

By Cara Bonnett
Duke Office of News & Communications

Durham, NC — Ed Hammond, who helped design Duke’s first electronic health record 40 years ago, gets a firsthand reminder of the need for personalized medical care every time he visits the doctor. “My son also works at Duke and has the same name as I do,” said Hammond, a professor of community and family medicine and biomedical engineering. “There’s almost a 1 in 10 probability that when I’m seen, it will be my son’s record. It’s understandable: Names are not the best identifier.” Inspired by new efforts to put information technology to work in transforming health care, Hammond, a national expert in data standards and health informatics, came out of retirement last year to head the new Duke Center for Health Informatics.

The center, which brings together Duke’s Schools of Medicine and Nursing, the Pratt School of Engineering and the Fuqua School of Business, will train the next generation of doctors, nurses and health-care administrators in implementing and managing electronic medical record systems to improve patient care. At least 50,000 health-care informatics professionals are needed in the next few years to help meet a federal mandate for digitization of all health records by 2014.

Stimulus Funding from the American Recovery and Reinvestment Act

Ed Hammond, “Curriculum Development Centers,” National Institutes of Health, $1,820,000 for 2 years. Ed Hammond, “Consortia for University-based Training of Health IT professionals in Health Care,” National Institutes of Health, $2,167,121 for 3 years. Hammond has won two stimulus grants under the American Recovery and Reinvestment Act totaling just under $4 million to get the training program started.

Duke’s programs will include a new Master of Management in Clinical Informatics degree, being offered for the first time this fall through Fuqua, as well as degrees from the certificate to the doctoral level. The center builds on a rich tradition of health informatics at Duke, which started one of the nation’s first programs under Hammond’s guidance in the 1970s, said Meredith Nahm, the center’s associate director for academic programs. Bringing together more than 50 Duke faculty, the center will emphasize an approach that includes medicine, nursing, business, economics, biomedical engineering, computer science and public policy. The goal: designing interoperable systems that present customized data for different uses. “Because nurses and doctors use information differently, for example, they’re interested in different aspects of the same information,” Nahm said. “The systems need to pivot to present information in a way that’s appropriate to the situation and a particular user.” System integration issues make it difficult to share the data that clinicians need to see the entire picture of a patient. And incomplete information can result in medical errors, which claim as many as 98,000 lives each year, according to a report by the Institute of Medicine. “As we develop an interconnected health system, medical records can’t exist in silos,” said Constance Johnson, director of Duke’s nursing informatics program. Hospitals have lagged in adopting analytical tools that would allow them to capitalize upon existing data stores to increase efficiency, reduce costs and improve health outcomes, said Jeff Ferranti, the health system’s associate CIO for health analytics and patient safety. The federal government plans to distribute $19 billion to implement electronic medical record systems, now in use by only about 8 percent of the nation’s 5,000 hospitals and 17 percent of its 800,000 physicians. “We’re at a critical crossroad: Our ability to gather data has outpaced our capacity to aggregate information to advance care,” Ferranti said. “That’s the primary motivation for the center. We’re creating a learning health care system, where the data collected isn’t just a byproduct of care but is reintegrated into the process, where it is aggregated and synthesized to identify trends and improve patient care.”

Duke, for example, has collected data since 2004 on patient safety incidents – an estimated 1,800 reports each month – and aggregated the data “to identify problems before they become problems,” Ferranti said. “Before electronic records, we had 23 disparate, paper-based reporting systems. Now we have five years of codified safety information that we can use to study issues from falls to transfusion deviations to adverse drug events.”

The new center will leverage Duke’s strong integration between health system operations and research by offering students access to Duke’s data warehouse, which contains more than 3.8 million patient records from the system’s three hospitals and 100 clinics in the Triangle area. “At the end of the day, what we’re really doing is speeding the translational process from bench to bedside to public health initiative,” Ferranti said. For Hammond, the center offers new hope for putting health data to work to improve the human condition. The past 40 years have brought technological advances that enable new possibilities, he said, from tools that can help doctors tailor treatments to individual patients’ needs to software that researchers can use to identify the best candidates for clinical trials. “We live in a new world, and we need new, innovative thinking to create a seamless system, without boundaries, where we can exchange data across different sites of care, to create a single complete picture of what happens to the patient,” Hammond said. “This is an exciting time.” The creation of the center, which is housed within the Duke Translational Medicine Institute, was supported by a grant from National Center for Research Resources (NCRR) through the American Recovery and Reinvestment Act (ARRA).