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U.S. health system could undermine EHR progress

Madison, Wis. — The nation's dysfunctional healthcare system may undermine any progress in patient care made possible by the adoption of electronic health records, according to a featured speaker at this week's Digital Healthcare Conference.

Jeff Grossman
Dr. Jeff Grossman, president and CEO of the University of Wisconsin Medical Foundation, offered a CEO's perspective on the role of IT in healthcare delivery. As he outlined the remaining barriers to the adoption of secure, effective electronic health records (EHRs), he expressed his belief that the United States, the only major industrialized country without universal health insurance, has been too isolated in its approach to providing access to healthcare.

"The notion of comparative health systems is very important and is something to which we haven't paid enough attention," Grossman said. "We've been too isolated in this area, and we need to be more international in our thinking."

Grossman declined to endorse the specific model of any nation, but said America's existing system, which leaves an estimated 45 million people without health insurance coverage, will mitigate any cost and qualitative benefits derived from EHRs. That doesn't mean healthcare providers should not attempt to create information technology record systems, but it does mean they should not expect electronic records to overcome what Grossman called the "perverse incentives" in the current U.S. healthcare model.

"You can't fix that with electronic health records," he said.
Grossman, who tracks developments in clinical healthcare, also outlined several strategic challenges presented by new technology. From a financial standpoint, healthcare executives are confronted with how fast to make investments, how large the investment should be, and how it should be amortized, a commitment that often has be based on intuition because of weak evidence on the efficacy of EHRs.

As organizations dig down into their operations in an attempt to build a workable network architecture, they may not like what the find, Grossman said, but they have to drive the project forward even while empathizing with the inevitable cultural resistance. And he cautioned against thinking about IT integration strictly in terms of return on investment, but as an underlying driver of quality.

Dr. William Yasnoff, managing partner of NHII Advisors, described a community-based eHealth Trust model that, in his view, can build the high level of public trust necessary for the widespread adoption of EHRs.

NHII stands for National Health Information Infrastructure, but the word national should not imply that Yasnoff believes in national information infrastructure models. He views them as a recipe for failure, and his firm instead helps communities and organizations develop health information infrastructure.

With a national approach, Yasnoff said the probability of failure would be "150 percent." The United Kingdom, he noted, has spent billions of dollars to develop its health information infrastructure, but the first thing the Brits did was divide the project into five regions because "they know these statistics."

Yasnoff said the eHealth Trust model could work on a regional basis, but described it as a community-based model with its own statistical underpinning. For example, public surveys indicate that 72% of consumers support electronic health records, and 52 percent would pay at least $5 a month to have their medical records stored in an electronic format. With that minimum $60 annual charge, employers could make eHealth Accounts available to employees as part of a cafeteria plan.

For a sufficient revenue flow, each plan would require 100,000 people (at $60 a year) to generate $6 million, $1 million of which would go to a local, non-profit board that would self-regulate the trust. The rest would go to the vendor, selected through a Request for Proposal process, which builds the system at no cost to local healthcare providers in exchange for a long-term contract that would guarantee the vendor operational control and ownership of system software.

"If you charge patients $5 a month, you can operate it for less than $20 per year, per patient - probably a lot less," Yasnoff said.

The eHealth Trust model requires a central repository to store lifetime health records and secure data files that only an authenticated patient user can grant access to.

To mandate cooperation among stakeholders, Yasnoff recommended leveraging the federal Health Information Portability and Accountability Act (HIPAA). "We don't often think of HIPAA as a friend," he said, "but HIPPA is an existing mandate. It requires information to be provided upon patient request."

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