Healthcare IT’s identity crisis: A conversation with James Templeton

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As both a scientific director and an educator, James Templeton possesses an interesting perspective on the current power, and problems, of healthcare IT. He is an Assistant Professor of Biomedical Informatics at Nova Southeastern University. He is also a Scientific Director for Astellas Pharma, working in the pharmaceutical industry for nearly 25 years. He holds a Masters in International Business, a Ph.D. with a concentration in Biomedical Informatics, and is currently completing a Masters in Medicinal Chemistry.

I spoke with Templeton to gauge his perceptions of the past, present and future of healthcare IT. His insights describe not only an industry in the midst of tremendous transition, but also in search of its identity.

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)

Taylor: What areas of work do you perform at Astellas Pharma?

Templeton: We focus on a number of disease states. The area that I focus my attention on now is urology, primarily in the field of overactive bladder and other urological diseases that are associated with that. I work with a team of field scientists, they are called medical science liaisons, and I am the director of the team for the West Coast. We bridge the internal and external research that is being conducted in the field of urology.

We work with internal research departments of Astellas and we help bring them information from the external sources as to what may be most relevant, most pertinent, most cutting-edge, and then we take our information and our research studies that we’re working on and we will work with our external colleagues to try to implement those and to move the science forward.

Taylor: With your experience and on-going work, how would you describe the current state of healthcare IT?

Templeton: I would say, we are slowly finding our way. We have done a fairly good job with electronic health records in terms of putting us on the map, but there’s still a long way to go. We need to look beyond the electronic health record and focus on things on a much larger scale.

For example, I think we really need to focus on health IT security. That’s one of the biggest vulnerabilities that we have. It puts a lot of us at risk in a variety of different ways. By healthcare IT security, I mean the confidentiality, the accessibility and the integrity of the data that’s being housed. We have seen in some instances where hackers have been able to gain access to large-scale healthcare databases with insurers. That robs us of our confidentiality, but there are a lot of other aspects of healthcare IT security that I think could put us at risk.

For example, if the availability of information was somehow cut off or no longer accessible, then clinicians may not be able to make the appropriate diagnosis. They may give medication that would put the patient at risk. They could possibly perform surgeries that are incorrect or unwarranted. There’s many varied risks that are associated with healthcare IT that needs to take a lot bigger attention, and a lot more focus on in the future.

Taylor: Some feel as though government regulations have helped with issues such as healthcare IT security, but they have been overly restrictive in other areas, such as Meaningful Use. What is your opinion on how regulations have influenced how technology is used in healthcare?

Templeton: It’s a complex beast because once you start instituting bureaucracy and layer thousands and thousands of pages of detailed laws or instructions or regulations, you sometimes can lose sight of what you are really trying to accomplish, and in order for us to be able to have a cohesive, consistent plan across the entire nation, to be able to demonstrate that health IT has a vital role in this, we need to have regulations that make sense, that are easy to interpret and easy to implement. Or at least, can be implemented in a timely fashion. Oftentimes the regulations are so burdensome and so complex that no one really has a clue as to what they need or they take years of study to be able to understand what they need.

Taylor: In addition to the government’s ongoing role in the evolution of healthcare IT, vendors have been a major influence on the industry as well. Again, some feel as though their influence has been more positive while other feel vendors have created many day-to-day difficulties for clinicians. 

Templeton: I would have to agree more with the latter part of your statement. Some of these vendor issues are creating huge road blocks for us moving forward, not only in terms of health IT specifically, but also healthcare in general.

One of which is that EHRs still do not have a single common language that everyone speaks, so that you could take an EHR from one vendor and easily translate it to another vendor. It’s things like that that can cause a disparity between a patient’s care and, yes, there’s going to be government regulations. There’s always going to be government regulations, but the bottom line is that we are trying to improve the healthcare system and in order to do that we have to make things that are user-friendly, that do have tools, that are easily distinguishable, that people can be trained on a vendor system, and that training can translate to other vendor systems because there is a similar platform amongst how things are being done.

Healthcare IT faced a similar challenge several years ago with medical imaging. Each vendor had created a proprietay system that created and stored the images, creating an enormous challenge for the healthcare community. Issues arose when trying to manage the ever growing body of medical imaging that was being produced. Standards such as DICOM (digital imaging communications in medicine) as well as PACS (picture archiving and communication systems) were developed that provided a strong framework moving forward. The American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) worked together to create the standards in the early 1980’s. These lessons would serve us well when considering today’s challenges. Healthcare IT should always maintain a vision of easing the burden on healthcare, interoperability of EHR’s is certainly an area of need.