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Thompson at a Senate appearance earlier this year. Credit: U.S. Department of Health and Human Services.
MADISONU.S. Health and Human Services Secretary Tommy Thompson announced Wednesday the first part of the government's plan to establish a national health information infrastructure in 10 years and bring electronic health records to every patient. HHS
also released a report, prepared by National Health IT Coordinator Dr. David Brailer
, which outlines the "Decade of Health Information Technology
," a joint public-private initiative with four major overall goals and several specific actions.
"America needs to move much faster to adopt information technology in our health care system," Thompson said as he released the action report ordered by President Bush. "Electronic health information will provide a quantum leap in patient power, doctor power and effective health care. We can't wait any longer."
The creation of electronic health records and a network to connect them is at the heart of the plan. Several efforts, including the appointment of a special Leadership Panel, are underway.
"The federal government will provide a vision and a strategic direction for a national interoperable health care system, but will rely on a competitive technology industry, privately operated support services and shared investments," Thompson said.
Addressing more than 1,000 attendees at a Washington conference organized by HHS on the National Healthcare Information Initiative, Thompson said the panel will assess the cost and benefits of health information technology and report to him. In addition, $50 million in seed funding for community information exchanges will be provided to five states this fall, with plans doubling the investment in 2005.Dr. Barry Chaiken
, chief medical officer for ABQAURP
, a patient safety organization, said in reaction to the announcement: "The fostering of interoperability standards, if successful, will finally allow the easy and accurate transfer of medical information among facilities. This reduces the chance of caregivers using incomplete or inaccurate information while caring for patients. It appears that the federal government recognizes its responsibility to foster innovation and the acceptance of information technology to make care safer and more efficient. Although the acceptance of change will not be easy, I believe our health care professionals will embrace the use of information technology to improve the outcomes of their patients."
Decade of Health Information Technology Report
Brailer's report identifies potential policy options for providing incentives for EHR adoption. The health sector has been slow to invest in EHRs, with only 13 percent of hospitals reporting they had the systems in 2002, and 14 to 28 percent of physicians' practices. Some incentive options to be reviewed include:
- regional grants and contracts to stimulate EHRs and community information exchange systems;
improving availability of low-rate loans for EHR adoption;
- updating federal rules on physician self-referral that may unintentionally restrict investment and networks;
- using Medicare reimbursement to reward use of EHRs;
- using demonstration projects to test new concepts in Medicare of "paying for performance" linking payments to quality of care rather than volume of services only.
"This approach drives industry-wide change by focusing on the clinician and the consumer," Brailer said. "Our goal is to bring about improvement of health care from inside out. This transformation will require the collaborative efforts and leadership of clinicians, consumers, hospitals, purchasers, payers, technology companies and informatics thought leaders to make this groundwork for change a reality."
Peter B. Strombom, vice president and chief information officer for Meriter Health Services
in Madison, said, "America has the technology, the people and skills to make this a reality. The most significant obstacles today are competitive and political not the technology. The question that remains is the funding of this initiative. Many of the larger systems in the country, including Meriter Hospital, UW Hospital and St. Mary's Hospital, are already funding such initiatives from their own revenues ... but it is very costly. A set of defined standards must be developed to make the national network possible. This will also require a great deal of energy and funding. There are also many smaller organizations that cannot afford the investment. Indeed, the move toward an EHR is stretching the resources of all organizations."
The report also identified three broad phases of implementation: developing the market institutions that are needed for a healthy market to exist in health information technology; encouraging investment both at the clinical level and in a new national network and achieving high quality and performance accountability.Dr. Raymond J. Zastrow
, a family physician with Advanced Healthcare
in Mequon, reacted to these announcements by stating, "The federal push to promote informatic interoperability gives me hope that we're about to move beyond the 'cottage industry' phase of the EMR/EHR market and jump to the next level of maturity. It's hard to predict precisely how the complex interplay of technology 'driver' development, standards development, public/private sector development, and 'critical mass' of adoption will ultimately play out as the NHII, but it's exciting to think that a new infrastructure to support a better health care product lies just beyond a 10-year horizon.
"10 years may seem like a long time, but the undertaking is so very complex. The effort to produce the NHII has been compared to that of the Apollo program. However, today's announcement doesn't tell us how we'll know when we've arrived. There will be no defined end-point akin to a Neil Armstrong stroll on lunar soil, so how will we know that we've reached the EMR/EHR destination? I suspect that we'll know we've arrived when NHII is as ubiquitous and as taken-for-granted as the ATM banking network we now rely on so completely."
Health technology and government programs
Technology is also being infused into the Medicare program, as Thompson announced plans to allow Medicare users to access their information online. The Internet portal is expected to accelerate regulations for prescribing drugs online.
The president's April executive order also directed the Department of Veterans Affairs (VA), the Department of Defense (DoD) and the Office of Personnel Management (OPM) to report on how they will advance the adoption of health information technology. Their reports were also released today.
The VA, collaboratively with DoD, provided joint recommendations in their report on: lessons learned, the knowledge and technology transfers to be gained from successful VA/DoD data exchange initiatives, the adoption of common standards and terminologies to promote more effective and rapid development of health technologies and the development of telehealth technologies to improve care in rural and remote areas.
The OPM report explores a variety of options to leverage its purchasing power and alliances to advance the adoption of health information technology.
The "Decade of Health Information Technology"
report has been published and is available online.