Giving health care technology a boost

Health information technology strategy fact sheet

The technology is available, and experts are developing standards, but to get the health care community to move beyond paper-based recordkeeping, federal officials must carefully balance incentives and penalties, some health care reformers say.

Last week, Department of Health and Human Services Secretary Tommy Thompson unveiled the Bush administration's 10-year health information technology strategy. Among other things, the document details steps to develop a health infrastructure that will give every citizen a real-time electronic health record that any health professional can refer to when treating a patient. Such an infrastructure would help overcome many basic problems in medicine, such as harmful drug interactions.

Experts testifying before the House Government Reform Committee's Technology, Information Policy, Intergovernmental Relations and the Census Subcommittee earlier this month emphasized the need for such a central strategy, but also pointed out that health care in the United States is extremely decentralized.

The majority of providers are in the private sector, and resources are not spread evenly. Laws are in place to mandate some behaviors, such as the Health Insurance Portability and Accountability Act, which requires providers to take certain security and privacy precautions for electronic records. But for the most part, government officials must encourage rather than force change, according to many health care reform leaders.

The proposed strategy includes a series of programs and policies, such as the Consolidated Health Informatics (CHI) e-government initiative. Under CHI, all federal agencies involved in providing health care are working with the private sector to develop a vocabulary and messaging standards for exchanging health information within the federal environment.

One goal for CHI is to have the entire public health sector adopt technical and data standards. Health care providers would have to follow the standards if they provide technology or services to the federal government, said Karen Evans, administrator for the Office of Management and Budget's Office of

E-Government and Information Technology. The federal government represents more than a third of the country's health care spending -- a significant player in the market, she said.

Officials at HHS, which is leading the CHI initiative, issued the first 20 standards in two batches. The first was released in March 2003 and the second in May 2004. Those standards will be applied as agencies and hospitals develop new health systems. They also will be used to modify existing systems for greater interoperability.

Early in the process, officials are finding that "the wonder of standards is that implementation is where the rubber really hits the road," said Claire Broome, senior adviser to the director for integrated health information systems at the Centers for Disease Control and Prevention. "I think we're learning a lot about what is involved in making these standards work so we can make the systems work together."

One successful incentive used by HHS so far has been to help expand the IT capacity of hospitals and health centers so they can adhere to the standards, she said. "You're trying to build infrastructure capacity at the same time as you're trying to build ... simple applications for them to use," Broome said.

The idea of using federal money and grants to drive enhancements and new IT infrastructure at the state and local levels isn't new, but it was emphasized by experts brought together to produce a white paper released this month by the Center for Health Transformation. Former House Speaker Newt Gingrich founded the nonprofit center.

To create a complete infrastructure, the CHI initiative feeds into the federal health architecture. That architecture provides a framework for linking the daily business processes in hospitals and doctors' offices to the technology solutions and standards that CHI identifies.

Similar to the public safety arena, health care IT improvements aimed at fulfilling homeland security requirements will also serve as drivers for day-to-day needs.

Officials are developing a target architecture for public health surveillance systems to improve "interoperability between surveillance systems across multiple agencies and in the national health community," Evans said. "The program is conducting an assessment of existing and planned public health systems to begin the process of identifying opportunities for collaboration and possible cost savings."

Dr. David Brailer is leading those efforts as the national health IT coordinator, a position created by executive order in April. However, the leadership he provides must last beyond the current administration, health care experts say.

"As health IT initiatives are pursued, it will be essential to have continued leadership, clear direction, measurable goals and mechanisms to monitor progress," said David Powner, director of IT issues at the Government Accountability Office.

Making Brailer's position permanent and giving the coordinator budget power through legislation will be critical to implementing standards, Gingrich said. The position also will be important in deciding whether efforts to create interoperable records should focus on individuals' full electronic medical records or only on vital medical information.

"Just creating the office without the power doesn't get the job done," he said.

Gingrich proposed that the federal government follow industry and other countries by identifying a fixed portion of the money spent on health care specifically for IT. The center's researchers found that companies typically set aside 4 percent to 6 percent of their health care budgets for IT, but even starting with 1 percent would provide a significant boost, Gingrich said. At 1 percent, health IT spending in the United States would be about $7.9 billion per year.

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REWARDS FOR IT UPGRADES

Health reform advocates say incentives must be used to move health care providers into the 21st-century world of information technology. A study commissioned by the Center for Health Transformation suggests various incentives that might be useful. They include:

Incentive: Change legislation or regulations.

Example: Require fewer surveys of nursing homes or other health care facilities that use electronic health care records and have no quality-of-care deficiencies.

Expected outcome: Facilities will convert to electronic recordkeeping to avoid the cost of annual surveys.

Incentive: Provide federal funds.

Example: Offer federal funds to cover start-up costs for technology such as broadband access.

Expected outcome: Local officials will be inclined to pay for remaining technology costs if the federal government provides start-up money.

Incentive: Try private-sector incentives.

Example: Offer financial or other bonuses to health care providers and hospitals for adopting electronic records systems.

Expected outcome: Health care providers will push for changes in medical recordkeeping to earn bonuses.

Incentive: Encourage patients to participate.

Example: Waive copayments for patients who use hospitals and health care providers that maintain electronic health care records.

Expected outcome: Patients will prefer health care providers that charge no copayments.

Source: Center for Health Transformation