On May 3, 2010 the New York Academy of Medicine (NYAM) held the Update on Medical IT: What Every Health Professional Needs to Know sponsored by NYAM Informatics Special Interest Group and Columbia University’s  Center for Advanced Information Management (CAIM). The speakers were Dr. Edward H. Shortliffe, President & CEO American Medical Informatics Association and NYAM Trustee; Dr. George Hripcsak, Professor and Chair of Biomedical Informatics, Columbia University; and Rachel Block, Deputy Commissioner Office of Health Information Technology Transformation in the New York State Department of Health. The point of the meeting was

…to address the current evolution of Health Information Technology fostered by the American Recovery and Reinvestment Act (ARRA) of 2009, [whose] goals include reduction of long-term costs by modernizing healthcare through the use of information technology.

Key items covered included

• Federal government investment of $36 billion (in Medicare and Medicaid providers and through government agencies) to drive adoption of electronic health records by 2015
• Development of government-certified systems that achieve meaningful use (more on this later)
• Certification standards
• Reporting protocols
• Compliance with government-certified electronic health records (EHRs)

Sounds great…but, as usual, the devil’s in the details. Overall, the presentations were (admittedly by necessity) rather general – but this led to concerns and questions that the panel sometimes seemed reluctant to address. Ah, politics.

A key challenge: not merely measuring, but defining meaningful use. This turns out to be enormously complicated, as you can see here.  The conundrum lies in identifying a “sweet spot” provides reliable quantitative metrics on ARRA-funded system implementation and use, while considering variations in practice environments. No mean feat.

Another gargantuan challenge is EHR compliance. Again, these reports not only have to be quantitative to be meaningful, but must also account for qualitative data, be compatible with systems from different manufacturers despite developmental compliant, and somehow deal with the proprietary EHR systems already in the field.

Let’s not even talk about security and the Health Insurance Portability and Accountability Act (HIPAA). No, really – let’s not. Except for HIPPA-2, which calls for changes in patients’ procedure payment and insurance notification options that the presenters acknowledged was difficult, if not impossible, to implement.

All this said, however, there’s progress being made, and the effort itself bodes well for an efficient, less costly and possibly universal (yes, international compliance is being explored) EHR system.

You can track the meaningful use discussion at the Meaningful Use Workgroup and review bioinformatics research at the Journal of Biomedical Informatics.

In Technology Review: Cell on a Chip, Lauren Gravitz reports that researchers at Rensselaer Polytechnic Institute in Troy, NY, have created the first artificial cellular organelle. This “cell on a chip” will help researchers understand how our bodies produce the widely-used blood thinner heparin.

This is a critical step. After its discovery nearly a century ago, heparin remains almost impossible to create in a laboratory, and so is still made from pig intestines – a procedure susceptible to sometimes lethal contamination.

Fake cell: This microfluidics chip can replicate the activity of one of the eukaryotic cell’s most important, yet least understood, organelles–the Golgi apparatus. Researchers hope that it can help them understand how to create synthetic versions of important drugs such as heparin. Credit: Courtesy JACS

The central mystery is the process by which a cellular organelle called the Golgi apparatus, converts proteins to sugar-studded glycoproteins. To emulate the Golgi’s workings, researchers created their very own artificial cell organelle – a small microfluidics chip – that acts as a precise, controllable, (eventually) automated Golgi analogue.

Funding and serendipity aligned, bioengineered heparin may enter clinical trials within five years.