HHS outlines plan to increase national adoption of health information technology

Washington -- A rapidly evolving federal effort to broaden vastly the use of health information technology is unlikely to get far unless the government can prove to physicians that there will be long-term benefits.

"We need to do better by our patients, and we certainly need to do better by our medical professionals," said Health and Human Services Secretary Tommy Thompson.

He laid out the department's vision and strategy at a recent government conference on health care IT in Washington, D.C.

"We see patients with records that are always current and always available so that services are not duplicated," Thompson said.

"We see systems where records are clear and accurate and legible so that medical errors are avoided. We see electronic health records systems that don't just provide the patient's record, they also give the doctor access to the treatment information he or she needs."

With those goals in mind, David Brailer, MD, national coordinator of the initiative, laid out the framework his office has developed in the three months since President Bush named him to the newly created post. He described it as a broad outline of priorities and strategies for encouraging the greater adoption of health information technology.

Ultimately, he hopes his office will spur the creation of a national infrastructure of information technology that allows the medical community to communicate efficiently and securely.

As part of that effort, HHS has launched multiple demonstration projects designed to create national standards by which physicians can gauge electronic systems offered on the market. Medicare has joined a national alliance of purchasers and payers, according to Mark McClellan, MD, PhD, head of the Centers for Medicare & Medicaid Services.

"We'll be working with them, supporting their efforts to create a common approach to encourage health information technology adoption. Coordinating with the private sector to reduce the cost of adopting an effective electronic health records system will help overcome the barriers that exist today to electronic records," he said.

CMS is also working on electronic prescribing with the intention of launching a voluntary standard by the beginning of 2006.

The Medicare reform legislation passed last year calls for the program to move to an electronic prescribing system, but not until 2009.

Under the heading of financial incentives, HHS officials said the department would roll out grants to regions, states and communities to build the groundwork for a national infrastructure of interoperable electronic records systems.

Physicians also could get their own incentives in the form of low-interest loans and Medicare reimbursement for the use of electronic medical records, both possibilities that the department is examining.

HHS officials hope these measures can push physicians over the tipping point.

According to American Medical Association Board Chair J. James Rohack, MD, the technology is there, and physicians understand the need to wring waste out of the system.

"If they can look at something that will allow them to provide better patient care and decrease redundancy in the system so that they have more time to spend with their patients, they'll embrace it," he said.

Some physician practices already have taken the plunge.

"There are a few shining lights out there of organizations that have been able to make the investment in money, people and training to achieve some results that we hope will go throughout the country," said Robert C. Goldszer, MD, associate chief medical officer and director of primary care at Brigham and Women's Hospital in Boston.

The 93-physician network has implemented an electronic records system that not only makes his job easier but also has demonstrable benefits for patients, especially those with chronic conditions that require the attention of multiple physicians within the system, he said at the conference.

"Our goal is one chart per patient, and the necessary information to manage these patients will be available to the necessary providers in a convenient way, thereby achieving ... greater value, better outcomes, better experience, lower cost," Dr. Goldszer said.

Cost, compatibility still obstacles

That might be easier said than done, though, for other physician practices.

While many hospital systems and primary care networks have been able to adopt information technology that efficiently shuttles patient data from one site to another, solo and small practice physicians have been wary of expensive and often unproven computer systems.

"Physician practices will adopt information technology only if they can afford the significant cost of new hardware and software," said William F. Jessee, MD, president and CEO of the Medical Group Management Assn.

The cost of an electronic health records system averages $30,000 per physician, according to the American College of Physicians.

The cost problem is compounded by vendors' focus on proprietary systems that work well for large networks, such as hospital and medical center systems, but fail to meet the needs of the small practices in which the bulk of physicians work.

"Like many private-sector industries, if they can do a deal with a large system and automatically capture 500 to 1,000 physicians, that's a little easier than trying to capture them door to door," said the AMA's Dr. Rohack.

Physicians in small practices would be better served by information technology that lets them communicate more efficiently with payers and other physicians, he said.

Up to this point, physicians have had to deal with electronic medical records that did not even work with other information technology within their own offices, such as electronic prescribing systems. They will need to be assured that health information technology reduces, instead of adding to, their need to input patient data, Dr. Rohack said.