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Here's Technology To Your Health
by Danielle Belopotosky
When presidential-debate moderator Bob Schieffer of CBS News asked President Bush to explain America's rising healthcare costs a month ago, Bush blamed the issue in part on the lack of information technology in the healthcare system.
"It's the equivalent of the buggy-and-horse days, compared to other industries," Bush said. He then added, "People tell me that when the healthcare field is fully integrated with information technology, it'll wring some 20 percent of the cost out of the system."
Whether that prediction proves true or not, the Bush administration is moving forward with a health IT plan. In April, Bush issued an executive order that called for a 10-year plan for widespread IT deployment, with the cornerstone of that plan being electronic health records. And in May, Health and Human Services (HHS) Secretary Tommy Thompson appointed Dr. David Brailer as national health IT coordinator.
By July, Brailer had delivered a framework of 12 strategies to bring e-health records closer to reality. "There is real promise here," he told doctors and medical experts at a conference in October. In a world of competing ideas, he said, the role of the government must be determined.
For The Records
With more than 650,000 licensed physicians, 6,000 hospitals and healthcare centers, and 12 million healthcare workers in the United States, experts have said that the adoption and implementation of an e-health records system will require federal and state leadership, industry-wide retraining, a well-funded public-private partnership, and technological innovation.
Bush's executive order established Brailer's office, which developed the strategy for deploying such a system. The goal is to enable patients and doctors to access the system anywhere, anytime, while also protecting patient privacy and reducing medical costs and errors. According to the strategy, HHS will review possible policy incentives, such as regional grants to develop a health IT infrastructure, loans for providers, and other financial incentives for insurers, physicians and healthcare centers to adopt an e-health system.
"The single-biggest thing that could happen next year is the implementation of some incentive program," said Janet Marchibroda, the CEO of eHealth Initiative, a nonprofit organization whose mission is to improve health care through technology.
The cost to implement a system could reach $700 billion, according to some experts. Marchibroda said the estimates range from $10 billion to $193 billion for five years. Bush has promised to double funding to $100 million in fiscal 2005 for health IT projects to help establish "best practices" and create models to facilitate growth.
Several bills also were introduced in the 108th Congress. One Senate bill, S. 2421, aims to reduce medical costs using information technology. It also calls for various financial incentives, including grants, matching funds and revolving loans.
Another piece of Senate legislation, S. 2710, would establish federal data and communications standards. And companion Senate and House measures, S. 1729 and H.R. 3035, would provide funding for equipment in an effort to reduce medical errors. The Institute of Medicine attributes as many as 98,000 deaths to preventable medical error in hospitals per year.
E-health advocates hope that legislation to create financial incentives for e-health records will move quickly in early 2005.
In Pursuit Of Interoperability
On Monday, Brailer's office requested public comments on how to create a health information network. "More needs to be done to achieve interoperability and to determine the process by which these tasks should be pursued in the public and private sectors," he wrote in the request, which had been scheduled for a summer release.
Twenty-four questions address complex issues, including how to build a medical internet, who would own and operate the network, what privacy standards should be implemented and what role government should play. The comments are due by Jan. 18.
One of the greatest challenges in implementing an e-health system may be the ability to communicate across networks, said David Lansky, director of health programs at the Markle Foundation. "Our concern is that there may be [e-health records] in doctors' offices, but there is not enough attention paid to how these end up talking to each other," he said.
The concern includes how patients would be identified. "A national patient ID would be unlikely and unwise," Lansky said. "The control should be up to the patient," he added, but the technology to share information would be in place.
Both the federal and state government need to look at regulations "that were created by former policies that never anticipated this [e-health records]," Brailer said at the October health IT conference, and focus on "what regulations we need to do a way with."
For example, in Georgia, and a handful of other states, it is illegal to transmit patient data electronically. In California, a patient cannot view laboratory results online without prior physician consent. Indiana recently launched a Health Information Exchange program that involves 17 hospitals, 30 percent of physician practices, homeless care systems, and public-schools clinics that represent some 1.3 million patients. The project includes an infrastructure that supports a messaging system and information sharing among state healthcare institutions.
The Center for Health Transformation, an organization founded by former House Speaker Newt Gingrich that aims to bring American healthcare into the 21st century and reduce costs, has developed a plan to guide state governments in writing policies that jive with new federal regulations. To make an e-health records system work, Marchibroda said, we "need support on the ground" by "working with communities and regions to make this work."
Leadership In The Private Sector
Physicians in small offices, community hospitals and health centers may need financial support, however. The costs are estimated to run more than $20,000 per physician, according to experts.
Connecting for Health, a working group of the Markle and Robert Wood Johnson foundations, suggests that small and medium-sized practices could need "incentives in the range of $12,000 to $24,000 per physician," per year, which translates into $3 to $6 per patient visit each month. That is why Marchibroda said incentives may be "the most important thing to tackle."
While Brailer's office is hammering out a national framework, though, some private entities are spearheading the initiative through both large-scale and small programs, with some aid from the federal government. In October, the Agency for Healthcare Research and Quality announced $139 million for 100 grants to hospitals, providers and communities in 34 states.
Sacramento-based Sutter Health said it plans to spend $1 billion over the next decade to provide 27 northern California hospitals with a new IT infrastructure, as well as equipment for electronic prescribing. Its e-health records system is set to be up by 2006, beating the Bush administration's goal by eight years. Kaiser Permanente also is working toward installing a system by 2007. And the Mayo Clinic has been using electronic medical records since 1994.
"As folks like Sutter Health, Kaiser and Mayo [are] building systems" that move the rest of the industry toward standards and interoperable systems, Marchibroda said, "when the rest of the world catches up, they will be able to interoperate. We don't want to move backward to get there."
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