The Road Towards Integrated Healthcare IT in the U.S.

By Stacey McDaniel

The healthcare industry is going through a period of rapid growth across the country. In fact, the U.S. government predicts that by 2014, total healthcare spending will double to nearly $3.5 trillion, accounting for 18.7 percent of the gross domestic product, up from 15.3 percent in 2003.

To curb rising healthcare costs, the Bush administration is pushing several initiatives aimed at automating the industry. In an effort to cut annual healthcare spending by 10 percent, President Bush in 2004 established a national goal of assuring that most Americans have electronic health records (EHRs) within the next 10 years.

Meanwhile, the Department of Health and Human Services (HHS) is working to promote the use of technology to improve patient safety. A significant part of this effort is a new system that would allow doctors and healthcare providers quick, reliable, and secure access to EHRs regardless of when and where care was received. Information would be protected by security and privacy standards. Such a system would also provide consumers and patients with greater control of their health records.

According to a nationwide poll conducted earlier this year by the Computer Systems Policy Project (CSPP), a CEO policy advocacy group focused on U.S. competitiveness, nearly 70 percent of Americans are in favor of integrating IT into the nation's healthcare system. With the support of the majority of citizens, perhaps the government initiatives underway to build a nationwide healthcare IT system will take hold sooner rather than later.

Office for Health Information Technology

In 2004, the federal government created the Office for Health Information Technology to oversee President Bush's objective for widespread adoption of interoperable EHRs. Headed by David J. Brailer, the Office of Health Information Technology has four primary responsibilities:

• Serve as senior adviser to the President and the Secretary of Health and Human Services on health information technology programs and initiatives.
• Develop and maintain a strategic plan to guide nationwide implementation of interoperable EHRs in the public and private healthcare sectors.
• Coordinate the spending of approximately $4 billion for health information technology programs and initiatives across the federal government.
• Coordinate outreach activities to private industry and serve as the catalyst for healthcare industry changes.

Moving Forward: New Requests for Proposals

In early June 2005, HHS released requests for proposals (RFPs) for a National Health Information Network (NHIN) meant to facilitate exchange of healthcare information nationwide while still protecting patient privacy. The requests asked vendors to design and develop a prototype network. More specifically, the RFPs covered the following projects:

• Create an Internet-based prototype for a national healthcare network so that doctors and hospitals can share patients' medical records.
• Choose one set of data standards for how hospitals, doctors, and others would collect, store, and ship such records.
• Certify EHRs so that they would meet set data and security standards.
• Engage states to expand and clarify just how electronic medical data could be kept secure.

In addition, HHS has issued RFPs seeking vendors to develop and draft possible e-health privacy and security policies, outline EHR data and standards, and certify EHR software.

Potential Hurdles

Building an automated nationwide healthcare framework is no small task, and does not come without its pitfalls and risks. Brailer has acknowledged some of the potential hurdles the healthcare industry will encounter in the process of automation:

• Adoption Gap  Brailer foresees an "adoption gap" of EHRs. More specifically, he predicts small medical groups will fall behind large medical groups. To remedy this gap, Brailer says the federal government will have to provide assistance to "level the playing field." Of course, the ultimate goal is to have all clinicians use the EHR technology.
• IT Security  Privacy and information control is an obvious concern when sensitive healthcare information is involved. Brailer recognizes the need to emphasize the benefits of IT over paper in terms of the ability to have more control over information security when that information is maintained electronically.

Proposed Legislation

Five bills that promote the adoption of healthcare IT have been introduced in Congress so far this year. Here are a couple of those proposed pieces of legislation:

• Senator Christopher Dodd recently introduced legislation that proposes awarding a half billion dollars a year for healthcare IT -- half in grants, half in loans. The bill calls for creation of a new executive office of National Health Information Technology. The head of this office would be appointed by and directly report to the President and would make recommendations for "federal reimbursement and payment structures that would encourage the adoption of information technology to improve healthcare quality and safety."
• At a press conference in mid-June 2005, Senators Hilary Clinton and Bill Frist introduced the Health Technology to Enhance Quality Act of 2005. The Act pushes for the establishment of an interoperable health IT system expected to reduce costs, enhance efficiency, and improve overall patient care. The Act sets aside $125 million in grants for regional and local consortiums to implement interoperable health information exchanges. It also highlights the need for a study of state privacy laws to determine how they might pose problems to the exchange of health information within and between states.

Conclusion

If the abundance of healthcare IT initiatives underway during the first half of 2005 is any indication of things to come, then don't look for the momentum to slow down anytime soon. Healthcare organizations should stay tuned, and follow the continuing push to integrate IT into a nationwide healthcare system. These organizations should also be prepared for possible changes in security and overall IT operations in the future. In the meantime, abiding by HIPAA regulations and taking care to employ comprehensive security solutions to protect sensitive patient information are the best paths healthcare organizations can take.

Stacey McDaniel has been writing about high-tech issues for more than six years.