BBI Washington Editor

WASHINGTON – Widespread adoption of electronic health records (EHRs) in the next 10 years. That is the goal announced by Department of Health and Human Services Secretary Tommy Thompson during the Secretarial Summit on Health Information Technology in mid-July.

A report on why such a system is needed and how to achieve it was prepared by recently appointed National Coordinator for Health Information Technology David Brailer, MD, PhD. And it is the result of President George Bush's call in April for EHRs for most Americans within 10 years.

Released at the conference, Bailer's report is titled "The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care."

The "Decade of Health Information Technology" was the theme Thompson returned to repeatedly in describing the potential for the EHR system.

"We have a vision for health information technology in America," he told reporters during a pre-summit press conference. "We see patients whose records are always current and complete, so services are not duplicated. We see systems where records are clear, accurate and legible, so that medical errors are avoided. Electronic health records systems don't just provide patient records. They also provide doctors the access to the treatment information needed to treat patients."

Thompson said he hopes that this effort will transform the delivery of healthcare by building a new health information infrastructure that includes EHRs and a secure network to link them nationwide.

"There are roughly 98,000 deaths a year due to medical errors," Thompson said. "This is not nearly good enough for a medical system as good as the one we have in the United States."

There is no reason, the secretary said, that America should not lead in healthcare technology as it leads in other technology sectors.

"Once this process starts, there's no putting the genie back in the bottle," he said. "It's time to bring medicine into the 21st century. The technology is there. We just need to put the mechanism in place to make it happen."

Thompson and Brailer sketched out implementation only in broad strokes , but they said some areas are being intentionally left open-ended for now.

"This is only a framework and not a full-blown strategic plan," Brailer said. "We have outlined very broad contours, which are intended to stimulate a dialog. This leaves a lot open, because we want to let the private sector and other agencies fill in to work together toward our goal."

According to the Department of Health and Human Services, the four goals of the program are to inform clinical practice, interconnect clinicians with an interoperable health information infrastructure, personalize care, and improve population health.

Brailer said that the program cannot succeed without engaged public- and private-sector activity. He said that it would require collaborative effort among clinicians, consumers, hospitals, purchasers, payers and technology companies to make the change.

"Remember that this is technology to achieve a non-technology goal," he said. "This is about improving patient care. It is bigger than just a technology story."

According to Brailer's report, the health sector so far as been slow to adopt and invest in EHR, with only 13% of hospitals reporting having such systems in 2002, and from 14% to 28% of physicians' practices.

The report also outlined incentive programs to boost acceptance and awareness. Some options include regional grants to stimulate use of electronic systems, Medicare reimbursement to reward use of EHR, and linking payments to quality of care rather than volume of services alone.

To get more precise ideas of the total cost, Thompson said that he would appoint a panel to assess the total costs and benefits of health information technology, and that he wants a quick turnaround time.

"I'm looking for optimists to lead this effort," he said. "If you're not sure we can get this done, you need not apply. We'll have a report in 60 days on how to do it and [how to] pay for it."

While not addressing what it will cost to implement the plan, Thompson did say that billions of dollars could be saved every year if an effective network was developed.

In addition to the leadership panel, Thompson said HHS would be exploring a range of strategic elements, including:

• Private-sector certification of health information technology products.
• Funding of community health information exchange demonstrations.
• Planning the formation of a private interoperability consortium.
• Requesting standards to facilitate electronic prescribing of medications.
• Establishing a Medicare beneficiary portal, which the Centers for Medicare & Medicaid Services (Baltimore, Maryland) said it will begin pilot testing later this year.

Senate Majority Leader Bill Frist (R-Tennessee), a cardiologist before entering politics, also spoke during the summit, calling the HHS report a "bold effort."

"We need to recreate fragmented healthcare sectors into a more coordinated, seamless system," Frist said. "All Americans should have that security of lifelong, affordable access to healthcare. This program will reduce cost and help with quality chasms."

He said that though we still have the best system in the world, the current state of the U.S. healthcare system was unacceptable."

He continued: "We need a system that is patient-centered, consumer-driven, and provider-friendly. Such a system is powered by three forces: information, choice, and control." And he said that it was the job of government to lead and set the framework to let the "ingenuity of the private sector to flourish."

Not straying from politics and election year issues for too long, Frist said there need to be changes in the tax code to allow "more equity in the system."

He also argued for changes in the litigation system to allow for what he called the "fair practice" of medicine. "Though this is not the purpose of today's meeting, it has to be part of the larger issue," he said.