A 'Tipping Point' Year For Health Care IT, Says HHS

But to hear Dr. Robert M. Kolodner tell it, there's plenty of reason for optimism, and even the notion that 2008, which he described as a "banner year," will prove to be a "tipping point" in the ramp-up to national implementation of health care technology.

Speaking at an opening keynote at Healthcare Summit Monday morning, Kolodner, the national coordinator, health information technology, at the U.S. Department of Health and Human Services (HHS), outlined the ways in which the federal government and a nationwide effort of both public- and private-sector health-care interests are working to move the national health-care model from one of prevention to one of prediction, using technology as a means.

"Only about 15 percent of our health relates to actual health care, and 85 percent has nothing to do with the health-care sector or health-care system. It's not about better health care -- it's about better health," Kolodner emphasized. "If I get a cold or whatever, do I have to go to the doctor or do I have an integrated resource to improve whatever ill I might have? In the same way the Internet transformed retail, IT can transform what we do today in health care."

Kolodner identified prevention (better health), coordination (barriers to care at multiple sites are eliminated), convenience and self-care as just some of the tenets. It's the convenience aspect -- the concepts of telecare and telemonitoring, for one -- where the competition among technology providers is heating up to achieve what Kolodner called a "robust, interoperable health IT environment that brings together EHR [electronic health records], PHR [personal health records] and an infrastructure for population health information."

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The Office of the National Coordinator for Health Information Technology (ONC), which counsels the Secretary of HHS on health care IT infrastructure, released its Federal IT Strategic Plan back in June. Kolodner reiterated the goals of the plan and updated Summit attendees on what work is being done in the five areas on which, he said, that interoperability goal hinges.

1. Governance

"We don't yet have a place where all the stakeholders can get together and interact in an honest fashion," Kolodner said. To that end, HHS and the ONC branched a successor organization in July 2008 -- right now called "AHIC Successor" -- to continue the work of the American Health Information Community (AHIC), the temporary federal advisory group of nationwide health-care leaders that had its final meeting on Nov. 12.

The successor panel had its first meeting last week, Kolodner said, and is getting its basic operations in line as well as looking to recruit a permanent CEO. The group is comprised of public and private organizational members from everything from state CIOs to pharmacy chains, and it has three federal liaisons associated: Kolodner, HHS Secretary Michael Leavitt and Secretary of Veterans Affairs Dr. James Peake.

2. Privacy and Security

Kolodner said the most controversial aspect of healthcare IT needs three questions answered: What is the right level of protections, what information needs to be available and for what purpose, and what are the different standards -- and do there need to be different standards -- for networked health information?

3. Standards in Health IT Products

Kolodner explained that more than 150 EHR products have been certified for use in the past two years, representing 50 percent of all vendors in the market and 75 percent of the overall EHR market as it currently stands. Standards, Kolodner reminded, are also the basis of the rules laid out in the Stark exception and anti-kickback safe harbor for e-prescribing, the two-year-old HHS exceptions intended to make it easier for hospitals and other organizations to donate EMR and e-prescribing technology to cash-strapped physician practices and other entities.

4. Networking

"That's where it all comes together," Kolodner said. "The network is where we take these standards that are implemented in different products and see how does it work, how do we work it through, and how do we drive it forward."

The interoperable network -- which HHS has been developing as the National Health Information Network (NHIN) -- seeks to include everything on the provider and consumer sides from community health centers, to federal, state and local government, pharmacies, laboratories and technology vendors like Microsoft, Google and others with integrated delivery system interests.

The NHIN will definitely impact providers, suggested Wes Rishel, Gartner vice president and distinguished analyst, because it will "reduce the friction of the patient hand-off."

"The problems we have in health care, both in quality and administrative hassle, occur most at patient handling. Because most health care is local, the first point of attack is often in the region," Rishel said Sunday. "It hasn't been easy doing RHIOs [Regional health information organizations, referring to a group of organizations with business interests in improving health-care delivery in the region, and largely agreed to be the building blocks of the NHIN.] But I think the ONC projects have gone a long way toward solving the technology problems, and come part way on solving trust issues."

5. Adoption

According to HHS, the current state of EHR adoption for hospitals is that about one in 10 nonfederal acute care hospitals in the United States has basic EHR in place. In ambulatory settings, 13 percent of providers have a basic system and 4 percent have a fully functional system.

Kolodner said more thorough data will be coming from the Department in January 2009, but in discussing the five major barriers to EHR adoption, it's still the financials that vex most organizations, with 66 percent of organizations saying they didn't have the necessary capital and 50 percent suggesting hesitation because of an uncertain ROI. Other factors, according to Kolodner, included difficulty of implementation (39 percent), productivity loss (41 percent), obsolete technology (44 percent) and whether EHR would meet the needs of the organization (54 percent).

Regardless of the hindrance, overall IT products aren't being used and implemented properly, Kolodner said. "You'll sort of get connectivity, but you won't get that whole flow."

And as for the incoming administration? One of President-elect Barack Obama's campaign points was that he hopes "to invest $10 billion over the next five years to move toward broad adoption of standards-based electronic health informations systems."

"There isn't much exchange of the thoughts behind that just yet, but we look forward to the day when we can exchange ideas," Kolodner said. "We believe he [Obama] does have commitment and he does understand that to change health care, he needs IT. It's not a magic bullet -- you can't just drop it in there. There has to be incentive and the motivation to use it properly."