Part 1 of 2
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WASHINGTON, July 21 (UPI) -- A 10-year plan to create a national health information network, the framework for which was laid out Wednesday by the Department of Health and Human Services, is daunting in its technological challenges, but also sorely needed.
It is ironic that U.S. healthcare can be so driven by technology in its research and delivery, but still be stuck in the cave when in comes to patient records and information processing -- far behind other industry sectors.
Only 13 percent of hospitals in 2002 said they had any type of electronic health record system -- along with only about 28 percent of physician practices. Where there are e-records, they likely are not in systems that can easily "talk" to any other systems.
"Technology is the centerpiece for transforming healthcare in America and we've reached a tipping point," HHS Secretary Tommy Thompson told a news briefing Wednesday. "The tipping point is here. We're going to have to get healthcare out of its horse-and-buggy days."
This week's Secretarial Summit on Health Information Technology in Washington is being held to develop an action plan that will include the federal government and its financial incentives, but mostly be developed and financed by the private healthcare sector.
"Ultimately this is not about technology -- this is something fundamental about how healthcare is given," said Dr. David Brailer, the new National Coordinator for Health Information Technology.
Brailer told the conference the government will help develop the framework and "create lines that all of you (industry) need to color into."
The goals are to get e-record systems installed at the community level of clinical practices -- physician offices and hospitals -- to build an information infrastructure that allows e-records to be transportable, to create an individual e-record for everyone that gives him or her more control over care, and to use e-records to improve the public health system, research and the development of quality data.
"Often, how we collect data is how we feed new knowledge back into the system," Brailer said.
It sounds confusing and it is, but it really boils down to healthcare information on a need-to-know, need-to-go basis.
It begins with the individual -- a compendium of a person's current health, health risks, past history and interactions with the healthcare system. That e-record is secured for privacy and released when the individual accesses care -- on a need-to-know basis -- to the appropriate professionals.
The journey begins at the doctor's office and works its way to a hospital, a testing laboratory, on up the path, if necessary, to specialists and specialist facilities. The e-record then travels with the individual, the need-to-go part, should the person move or change jobs or vacation so any physician, any facility, anywhere in the country -- should they need to know -- can access the data.
At the government level there is need-to-know, need-to-go as well, for public health and bioterrorism. Information from e-records might need to securely transfer, such as in the case of a patient with West Nile virus, to the Centers for Disease Control and Prevention in Atlanta.
There is a need-to-know also for medical research, requiring the data, stripped of personal identifiers, to be sent, perhaps in aggregate with thousands of other files, to universities and laboratories.
Finally, there is a need to know for consumers and healthcare professionals in a more general sense: What can the total accumulation of e-record data tell people about healthcare's best practices and trends -- what's working in Omaha that might work in Miami or Boston. What facilities are doing the most heart transplants, which are the best at hip replacements.
This system will be costly and take years to develop, but the potential rewards are great. It will result in overall better healthcare for Americans who about half the time are not receiving appropriate care. It will result in a significant reduction in medical errors that result in tens of thousands of deaths each year. It will lower healthcare costs for a country that spends multi-times more per person than other developed countries, but gets less quality. It will result in more information for research and development, and a better-equipped public health system that often reacts to a crisis rather than acts proactively to prevent.
The challenge: how to get there. U.S. healthcare is, after all, a local deal -- a loose confederation of doctors, hospitals, insurers and a myriad of other providers.
What technology is used lacks national standards to allow disparate providers to communicate properly. Even if they could "talk" to one another in a single language, however, there is no common technology platform on which to do so. The computer system in Dr. Smith's office in San Diego cannot talk to the big hospital system in Denver, or to the CDC in Atlanta.
"It's surprising to many people that the healthcare system today relies on paper. Electronic health records must maintain all the necessary health information -- the medical information as well as the billing information," Senate Majority Leader Bill Frist, R-Tenn., told attendees at a recent National Press Club luncheon.
"It must be accessible from any Internet portal," said Frist, who is a cardiologist by profession. "If someone -- from Nashville -- has an accident in Montana, immediately that electronic health record must be available. There must be seamless use among physicians and hospitals and healthcare providers, the patients and the consumers."
The healthcare industry remains behind technologically, but there is growing interest and a willingness to put money into electronic records, especially at the hospital level.
"The time has come. The industry is beginning to get it, finally, in terms of what a clinical system of electronic records can do," Lewis Redd, vice president and national health care practice leader at Capgemini Health in New York City, a leading health consultancy, told UPI in an interview.
"Access to good clinical information can reduce the cost of healthcare," Redd said. "The more you know about a case the quicker you can diagnose the problem and get them well. There is clear recognition that having clinical information in one place and accessible by multiple providers can reduce errors."
E-records can save by reducing duplicate tests and diagnostics -- a physician anywhere will be able to see Mr. Johnson already has had an MRI. The e-record will reduce errors -- the doctor will already know Mr. Johnson is allergic to penicillin. It will encourage better care because the physician will move treatment forward based on the previous care record.
Dr. William A. Yasnoff, the senior adviser to Brailer's team, found in his studies that a computerized physician order entry at one facility reduced costs by over 13 percent and reduced errors by 55 percent.
"Health IT should deliver complete medical information immediately for patient care when and where needed, including both patient-specific information and relevant decision support based on the latest scientific findings and guidelines," he wrote in a recent article in the Journal of the American Medical Informatics Association.
"We could save 10 percent ($140 billion out of $1.4 trillion each year) of healthcare costs, at least, with information technology," Yasnoff told health plans officials gathered in June at a national conference in Chicago.
Scott Wallace, president and chief executive officer of the National Alliance for Health Information Technology, told the insurers the pressure on the industry to take take action "is going to be excruciating."
He warned there could be strict federal regulations requiring it "if we as a private sector don't get around this issue."
The government is willing to help. Thompson said he will create a Leadership Panel that will report by this fall on the projected costs and benefits of setting up such a system. Medicare will lead the way, he said, through giving beneficiaries Internet access to their personal Medicare information and by pushing forward regulations governing e-prescribing of drugs.
While HHS is not going to fund the creation of the entire system it stands ready to put millions of dollars into development projects. It is funding programs to create national standards for laboratories, health billing, research and other medical terminologies.
Grants will be given to develop information exchange pilot programs in local communities - systems that set up the beginnings of the e-records infrastructure by allowing local physicians to access information about all the care a patient has received. These regional networks would then be tied together into a nationwide network, which would able to link to the government and public health system.
The government also will make low-interest loans available and give additional Medicare reimbursements to providers who invest in e-records systems.
The rest of the cost will fall heavily upon hospitals and health plans -- the healthcare intersections at the local and regional levels. Ten years may be optimistic, too, in terms of how long this process will take.
The healthcare industry, however, is more than capable of getting the job done. In Part 2 of this analysis we'll look at what one health system, Kaiser Permanente, can teach the industry about setting up e-records, as well as how to ensure privacy -- a critical concern in these systems. Also, the United States is not alone in this quest -- Britain and the rest of Europe all are looking at electronic health capabilities.
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