Federal commission to focus on easing the way to EMRs

Washington -- In an effort to get private firms moving on developing standards for electronic medical records, the federal government has launched a commission to start tackling some of the toughest stumbling blocks.

The American Health Information Community is a public-private collaboration that will advise the Dept. of Health and Human Services on how the health community can migrate away from paper records. HHS Secretary Michael Leavitt, who will chair the commission, is seeking nominations from both sectors to fill up to 17 slots on the panel.

Leavitt said ensuring that individuals' EMRs can be accessed easily and efficiently by medical professionals in different areas of the health care system is one of the most important issues that the new group will take on.

"The national strategy for achieving interoperability of digital health information is for federal agencies ... to work with private-sector health care providers and employers in developing and adopting an architecture, standards and certification process," he said. Leavitt pointed out that the government pays for more than one-third of all health care in the country.

In addition to announcing the collaboration, HHS issued four requests for proposals aimed at securing contractors to develop solutions to some of the stickier implementation problems. HHS is seeking firms to design plans to bring differing EMR standards into line with each other, certify technology products that physicians and others can buy, construct prototypes for an Internet-based health information network, and find ways to ensure interoperability amid privacy and security concerns.

These efforts are part of the Bush administration's campaign to get most Americans outfitted with a personal EMR within 10 years. The private sector has indicated that it wants the government acting as a partner in this undertaking, said David Brailer, MD, PhD, the national coordinator for health information technology. Dr. Brailer released a report last month noting that a group of Fortune 100 CEOs had insisted on strong federal involvement in the modernization process.

"The actions announced today build on the evaluation and strategies that we have developed in collaboration with the broad community of health care leaders," Dr. Brailer said after the commission and the requests for proposals were announced. HHS said it would set a good example by developing its own EMR standards for the Medicare and Medicaid programs.

But federal officials also made it clear that they have designed the new initiative merely to jump-start the process and that they expect private companies to take charge before long. The commission will operate for at least two years but no more than five, at which point a private-sector collaboration will assume responsibility.

"Once the market has structure, patients, providers, medical professionals and vendors will innovate, create efficiencies and improve care," Leavitt said.

The administration is committing a relatively small pot of money to the initial years of the decade-long effort announced by President Bush last year and is expecting the private sector to commit substantial resources of its own. HHS is spending $86.5 million on health IT during the current fiscal year, and the White House has asked for $125 million for next year. Some experts have estimated that it will cost billions to outfit the majority of Americans with EMRs.

In general, the AMA supports the development, adoption and implementation of national health information technology standards through collaboration with public and private interests.

Seeking doctors' input

The HHS chief did not say whether he would seek to appoint a certain number of physician representatives to the commission, but federal officials said they were paying close attention to doctors' needs.

"Physicians are one of the crucial stakeholders and decision-makers," said Scott Young, MD, director for health information technology at the Agency for Healthcare Research and Quality, which is part of HHS.

"We need input from physicians -- desperately," Dr. Young said.

At the same time, doctors need to pay attention to health IT developments on the national scale and volunteer their own input because of the major effect that any modernization will have on the way they practice, he said.

Agencies such as AHRQ are using research money to test electronic medical records in the field on a relatively small scale. The researchers are finding that the interoperability concerns slated for the commission's review are already forefront in many physicians' minds.

"It keeps coming up to the question of, 'If I put this in, how do I know it's not going to be the next Betamax -- that it's not going to be yesterday's standard?' " said Dr. Young, a family physician in Rockville, Md.

"We're still hearing from some boards of directors that they don't have much of an appetite to invest in this right now," he added.

There are more than 200 EMR products on the market today but no consistent criteria for determining quality and interoperability, HHS says. The department hopes to change that by securing a contractor to develop such criteria and give physicians the information they need to make informed purchases.

Doctors will become much more comfortable with investing in this technology once the government gets to the point where it can certify appropriate products, Dr. Young said. A federal imprimatur would be enough even for some of the smallest practices to seek out an EMR that will make sense for them, he said.