Medical Device Daily Washington Editor

WASHINGTON – When it comes to healthcare in the U.S., there is no shortage of explanations as to why there is so much waste, but the utility of information technology in stemming costs and improving care has never been fully tested for a number of reasons.

Among these is the privacy issue, but panelists at an event hosted by the National Press Club (Washington) said there is no practical way to ensure that no data breaches will ever occur and that healthcare information technology (HIT) will have to move ahead based on strong data integrity mechanisms and stiff penalties for those who breach data.

The panel, assembled by the Federation of American Hospitals (FAH; Washington) also argued for a stronger federal role in making healthcare data more easily piped from one provider to another, which was described as "liquidity." As is the case with financial liquidity, the view is that healthcare data liquidity needs a shot of capital from Uncle Sam.

Chip Kahn, president of FAH, said that funding for HIT as part of an economic stimulus package is needed to achieve a "a breakthrough in adopting an interoperable health IT system." He said a piece of legislation is in the works and that a number of central figures, including Rep. Pete Stark (D-California), the chairman of the House Ways and Means health subcommittee, is part of that team.

Although Kahn did not name a particular piece of legislation, Stark penned a bill last year, the Health-e Information Technology Act of 2008, which would require that the Secretary of Health and Human Services publish a set of interoperability standards by 2011 and provide financial incentives for adoption. Those incentives would phase out over time and would be paralleled by financial penalties for providers who do not make the e-transition. Under Stark's bill, physicians could receive as much as $40,000 over five years, and incentives for hospitals would hit seven figures.

Kahn stated that the incoming Obama administration is in on the talks, as are Senate Finance Committee Chairman Max Baucus (D-Montana), Ted Kennedy (D-Massachusetts) of the Senate Health, Education, Labor and Pensions Committee, and Rep. Henry Waxman (D-California), who chairs the House Energy and Commerce Committee. He said that these signatories "understand that the expectations of HIT will not be met without funding and leadership from Washington."

Bemoaning the "hurry-up-to-not-get-far strategies" of the past, Kahn also made the case that adoption of HIT "is only half the battle." A reasonably functional system requires "real-time linkage ... that first prioritizes the free flow of the most essential medical data."

Christine Anderson of government contractor Booz Allen Hamilton (McLean, Virginia), which published a report on HIT unveiled at the briefing, reiterated Kahn's point that electronic health records "alone are not going to get us there" because the existence of those records "doesn't ensure that my primary care provider will share" information with specialists.

She cited the need for "accelerants," including a need to "get out of paper." She said that EHRs will have to include data on prescription drugs, medical results and imaging data. Another ingredient is payment reform, which is needed because current reimbursement schemes provide no incentives to share data. "We believe public payers can lead this charge," she said.

Anderson also said "we think it would be a good idea to change the focus from products ... and to think more about the functions they should perform." She said the focus on function is essential because the software solutions are liable to be iterative in nature in any case.

She said there are "very large safety and quality advances from checking drug allergies," which reinforces the need for e-prescribing and will also help eliminate the illegible scrawl issue. All this will be for naught, she said, unless a system makes "this pharmacy lab and imaging history available at the point of care." She stated further that "we need to think about how to give caregiver access in real time."

In response to a question about EHRs on thumb drives, Don Detmer, MD, president of the American Medical Informatics Association (Bethesda, Maryland), said "there are thumb-drive strategies," but that "there are there also viruses" in some of those drives. He also said physicians would have to ask patients, "Are you sure it's up to date?" The possibility of data deletion is another consideration.

"There are clearly benefits and values to a thumb-drive strategy," he acknowledged. "Certainly the capacity to store data" in terms of cost is not an issue.

On the privacy question, Detmer said that fluidity of data is necessary, "but some people are scared of that kind of world" because it will never be perfectly secure. The only solution is good security measures and appropriate penalties, he said.

Kahn said that privacy policies will "either protect most of the people most of the time," or will create a machine that locks up data in the effort to utterly thwart security risks.

He said it might be more appropriate to let the Department of Health and Human Services deal with this question because Congress has exhibited little ability to come to a conclusion as to how to approach privacy.