HIT Washington Editor

WASHINGTON — The healthcare information technology (HIT) revolution is well under way, but a panel discussion on the final day of the recent World Health Care Congress here made clear yet again that just getting doctors and hospitals to buy computers and software will not do much to improve care and cut costs.

To really harvest the full value of e-health, the panelists agreed, a HIT superhighway is utterly essential, so much so that one panelist made the case for the kind of push for an interstate highway system provided by President Ike Eisenhower half a century ago.

Panel moderator William Winkenwerder Jr., MD, said HIT infrastructure "is not often a topic ... that comes to the top of one's mind" because the focus is typically on what will be necessary to get doctors and hospitals to join the Information Age.

"Digitizing all of healthcare," the former assistant Secretary of Defense for health affairs said, is akin to the function of "your nervous system. You can't get coordinated movement" without the nervous system, and healthcare cannot coordinate its moving parts without a digital central nervous system.

Kelly Cronin, director of the office for programs and coordination at the Office of the National Coordinator for Healthcare Information Technology, briefly discussed the HIT features of the American Reinvestment and Recovery Act.

"It's an exciting time for health IT," she said, noting that "we finally have significant resources" to expand the use of electronic medical records. Cronin noted that the provisions for HIT in the bill include "two big buckets of spending." One of these is a chunk of about $12 billion in incentives to providers who bill under Medicare and Medicaid.

Discussing a $2 billion slice of the remaining federal HIT pie, Cronin said "there are several grant programs that HHS is asked to administer," some of which will help build up the IT workforce via training programs. "It's not just the technical aspects of making software work," she said of the intent of these training programs, but also about "how healthcare works." Trainees who are about to enter the workforce need a solid grasp of this, even "at the community college level."

State grants are geared toward getting state government on board as well as the private sector in each state "to ensure that stakeholders across the state ... can all work together to create this infrastructure," Cronin said. She noted that 49 states have at least some sort of plan on paper, but did not identify the laggard.

"This grant program will be geared to helping their planning and implementation efforts," she said, but checkpoints are also in place to ensure that this use of federal monies yields a strategic plan at the very least. The task of tracking each state's progress won't be easy, though, partly because of a "huge degree of variation" in consent and privacy laws.

Regional extension centers will be set up for the task of "providing technical assistance and implementation support" for state HIT projects, Cronin said. The priorities for the hospital part of this effort are public hospitals and non- and not-for-profit hospitals.

All the same, "what most are interested in is how the incentives will be administered under Medicare and Medicaid," she said, including the definition of a "meaningful user," a phrase that is seems certain to occupy a fairly prominent place in the lexicon over the next few years.

"There will be a lot of public input over what is the right way to craft this definition," Cronin observed, noting that anyone who would refer to themselves as a "meaningful user" will be liable for "a lot of accountability." She also implied that the meaning of the phrase is unlikely to be static by remarking that the "definition is going to need a lot of refinement."

George Halvorson, chairman of the board and CEO of the Kaiser Foundation Healthplan (Oakland, California), said the integrated HIT effort at Kaiser is "sort of a microcosm of the entire healthcare system." This is because Kaiser's model enjoys a fairly extensive degree of vertical integration, thanks to the fact that the vast majority of physician, lab and pharmacy services are handled in-house.

"It is critically important to gather all the data about all the patients ... so the doctors in the exam room can have" the lab and pharmacy data when examining the patient. "When you put all those pieces in place, the results can be spectacular," he said.

Halvorson said a study of avoidable care expenses by the Commonwealth Foundation (Harrisburg, Pennsylvania) showed that "this country could have saved half a trillion dollars by avoiding" those needless expenses. "That's the kind of agenda we have to have for the country," he remarked, which starts with HIT.

Halvorson asserted that studies suggest that physicians who are treating children with asthma are "getting care right only 46% of the time. That means we're misfiring most of the time." He maintained that patients cannot get "the right care until we have computer systems that track" diagnoses and treatments exhaustively. He said Kaiser now has electronic health records for 10 million members, and all physician offices in the network are now paperless. "We're almost there in our hospitals," he said.

As for the effort to drive healthcare into the 21st Century, Halvorson opined, "it would be really silly ... to have the end result be a bunch of electronic data silos" that function as ineffectively "as the paper data silos we have today." Funding, he said, should reflect this priority, so buyers should insist on connectivity. "It should also be plug-and-play," he said, reflecting other comments heard during the three-day session. "We don't even want everyone in the same [HIT] system," he said, noting that data portability and availability are enough.

"What we have now is a lot of truncated data," Halvorson stated, which kills opportunities to develop longitudinal data sets. In the end, however, the objective is to enable patients to "get your medical record at home or if you're traveling in Paris," but getting to this degree of connectivity requires that "we have an infrastructure that's plug-and-play."

Halvorson suggested that EHRs for each of 300 million Americans might not be essential to wring meaningful savings out of healthcare. "We don't need a complete, multi-level data for all patients," but "every patient with chronic conditions and co-morbidities should have" EHRs that are portable and interoperable, he said.

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