HHS outlines plan to increase national adoption of health information technology

Federal officials set their sights on new standards that will make electronic records more viable for small and solo physician practices.

By Joel B. Finkelstein — Posted Aug. 9, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

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.

Back to top


Technology expansion

The Dept. of Health and Human Services recently announced several key initiatives that are expected to drive the effort to expand the use of health information technology.

Product certification: HHS is working with the private sector to establish a certification process based on minimum product standards of functionality, security and interoperability that would help physicians make informed purchasing decisions.

E-prescribing standards: The Centers for Medicare & Medicaid Services is working on a standard for electronic prescribing in Medicare with plans to publish a proposed rule this year.

Community exchange project: The Health Resources and Services Administration announced $2.3 million in seed grants for a program designed to implement community-based health information exchanges.

Medicare beneficiary tool: An Internet- and phone-based service allowing Medicare beneficiaries to access personal health information will be pilot-tested in Indiana this year.

Back to top

External links

Office of the National Health Information Technology Coordinator's "Framework for Strategic Action" (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn