Summer 2004 Edition

August 11, 2004

Recently DHHS Secretary Tommy Thompson convened a summit devoted to launching the Decade of Healthcare IT in the U.S. Secretary Thompson described his ambitious goals for a ‘wired’ healthcare system: one that is interoperable, produces high quality care with clinical decision support, is cost effective, integrates evidence from the bench to the bedside, serves the medically under-served, promotes consumer involvement and empowerment, leads to improved accuracy and privacy of healthcare information, and facilitates public health monitoring. Exactly the right messages to describe how IT can help healthcare.

Dr. David Brailer, the newly appointed National Coordinator for Healthcare IT, released his report outlining a framework for action for achieving these goals. This framework includes four principal goals: inform clinical practice, connect care providers, personalize care with improved consumer information and healthcare knowledge access, and improve population health through improved public health reporting. Again, the right messages to describe how to cross the quality chasm, wire the US healthcare delivery system, and transform healthcare delivery.

What's the good news?

It’s clear that this event was the Woodstock of Healthcare IT: a gathering of much of the country's healthcare and information technology leadership. Healthcare IT (HIT) has certainly been getting a lot of attention lately, and has even made it into the rhetoric of both of the U.S. presidential campaigns. The issue is now receiving increased attention both in the federal and state policy arenas but also among third party payers and employer-purchasers of health care services. The interest by the Center for Medicare and Medicaid Services (CMS) is noteworthy because as the world's largest payer for health care services, the policies that CMS implements are likely to be followed by private payers as well. If CMS were to stimulate the adoption of health care information technology through reimbursement reform, quality incentive programs, and possibly low interest loans or grants to federally qualified providers, this is likely to be the wave that crests and causes widespread HIT adoption.

What's the bad news?

While Dr. Brailer's framework and the announcements by Secretary Thompson have generated widespread interest and enthusiasm, more still needs to be done to move this industry, and the adoption of HIT, forward. The current administration's commitment to funding healthcare information technology adoption through public payer reform, or low interest loan and grant programs, has been anemic at best. In addition, the framework for action calls for a renewed commitment to informatics standards, essentially through adopting the Consolidated Healthcare Informatics standards established by the Federal Government. While this is laudable, these standards have not been adopted across the industry, nor have IT vendors been materially involved in establishing this standard set. And they feel no requirement to adopt them in the absence of customers saying it’s a requirement, or a federal mandate of some kind. The success of HIPAA (despite the considerable pain) was national adoption of a standard set of administrative transactions that have dramatically streamlined administrative claims management in this country. In the absence of regulatory pressure or reimbursement pressure through leverage of CMS payment mechanisms, progress may still be slow overall.

Also, the framework for action calls for increased consumer adoption of “PHR” (Personal Health Record) technology. While it is commendable to increase consumer adoption of information technology in support of healthcare delivery, care management, and empowered self-directed consumers, unfortunately it raised more questions than answers because of the ambiguity around definitions of PHR (not to mention Electronic Health Records or ‘EHRs’), and modes of interaction between personal health records and EHRs. Critical issues that remain to be solved are how these technologies interact, who maintains the credibility and integrity of the data, how is this data shared and access controlled in a clinically reasonable and responsible manner, and what mechanisms can provide assurance for patient privacy and confidentiality of their data.

Hats off to Secretary Thompson and Dr. Brailer for a truly landmark achievement. But, like Woodstock, now that the party is over the real work must begin to address these critical issues, and bring to life the vision of a ‘wired’ US healthcare system.

Blackford Middleton, MD, MPH, MSc
Clinical Informatics Research & Development
Center for Information Technology Leadership
Partners HealthCare, Harvard Medical School
Boston, MA

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation or the Health e-Technologies Initiative.