HHS contract would transform medical record keeping, health care

The National Library of Medicine, part of the Health and Human Services Department, has signed a $32.4 million, five-year contract with the College of American Pathologists to permanently license the college's standardized medical vocabulary and offer it free of charge to health care providers across the country. It is the first step in establishing a common electronic medical records system in the United States, much like the electronic data system banks used to transmit financial data between institutions.

"It's hard to overstate the significance of this," said Dr. John Mattison, assistant medical director for clinical systems with the Southern California division of Kaiser Permanente, one of the largest health care networks in the country. The contract ultimately will affect everything related to medical record keeping, from bioterrorism-surveillance programs to the quality of medical care patients receive, Mattison said in an interview with GovExec.com. The standardized vocabulary, the Systematized Nomenclature of Medicine-Clinical Terms, known as SNOMED CT, is considered to be the world's most comprehensive clinical terminology database available. The licensing agreement will allow health care providers, hospitals, insurance companies, public health departments, medical research facilities and others to incorporate the highly specific terminology into their electronic information systems. SNOMED has terms for more than 340,000 medical concepts.

In a related matter, HHS announced that the Institute of Medicine would design a standardized model of an electronic health record, which, once approved by the health care standards development organization known as HL7, would then be shared, free of charge, with all components of the U.S. health care system. HHS expects the model will be ready next year.

"We want to build a standardized platform on which physicians' offices, insurance companies, hospitals and others can all communicate electronically, which will improve patient care while reducing the medical errors and the high costs plaguing our health care system," HHS Secretary Tommy Thompson said in a statement.

The licensing agreement with the College of American Pathologists includes SNOMED's core databases in both English and Spanish, along with regular updates. The cost of the contract will be shared by HHS, and the Veterans Affairs and Defense departments. The National Library of Medicine will pay for annual updates to the database.

Currently, medical vendors and providers use many different proprietary languages, Mattison said. "SNOMED is the richest and deepest of any of the terminology sets in existence today," he said.

"We will see much more rapid advances in the knowledge base of medicine, we will see much more effective care delivered. If the patient elects to have that information shared-this doesn't violate any security at all-then the information can be translated from one system to another, from one country to another, in a way that its understandable and reproducible so that it's very accurate and very reliable and that today is very difficult to achieve. It allows for real portability of records, but still within the framework of confidentiality," Mattison said.

Mattison also expects the licensing agreement will result in important advances in public health and even the early detection of any future bioterrorist attacks. "When it comes to something like detecting bioterrorism, for example, if there's two cases that show up in one emergency room with a set of symptoms, and another one 100 miles away, and five more in the Midwest, and six in the South scattered around different hospitals, nobody's going to be able to identity that those in fact represent a cluster, and perhaps represent some bioterrorist event," Mattison said, "whereas if that information is coded in SNOMED, and rolled up into a surveillance [program], then early detection is not only plausible but likely."