Federal health IT panel hoping to broaden use of EMRs

Washington -- When it comes to addressing the problem of creating truly universal electronic medical records, the federal government wants physicians to know that it's on the case.

In September, Health and Human Services Secretary Michael Leavitt named 16 charter members to the American Health Information Community, or AHIC, a public-private collaborative that will spend the next several years recommending ways to migrate from paper to digital patient records. Within a decade, the Bush administration wants most Americans outfitted with an EMR that medical professionals can share with one other.

"The president has set a national goal to move health care from the paper age to the information age, and the American Health Information Community will help guide this transformation." Leavitt said. "My aspiration is for the community to provide stakeholders with a meaningful voice in a federal process that will ultimately shape health care for generations."

Representing the physician community on the panel is Douglas Henley, MD, the American Academy of Family Physicians' executive vice president. Leavitt chose him from a list of three potential appointees put forward jointly by AAFP, the American Medical Association, the American College of Physicians, the American College of Surgeons and the American Academy of Pediatrics. AMA Immediate Past Chair J. James Rohack, MD, and ACP Executive Vice President John Tooker, MD, were the groups' other recommendations.

Dr. Henley, who like other members will serve for two years, said IT concerns of smaller practices will be among the major points that he brings up with the commission.

"Most of the health care each and every day occurs in the ambulatory environment, and most of that occurs in physician offices, and most of that occurs in offices of fewer than 10 physicians," he said. "So this process needs to pay attention to the particular needs of the small- and medium-sized practice environment and the challenges they face."

With implementation and maintenance of even a small-scale EMR system typically costing tens of thousands of dollars, practices with limited resources must be sure they are investing in a product that will be truly interoperable, he said. By establishing standards and certification measures for health information products, the public-private community aims to assuage such fears.

Groups such as AHIC will play a high-stakes role in making health IT an attractive investment and one to which doctor groups are confident in committing funds, David Brailer, MD, PhD, national coordinator for health information technology, said in a recent issue of the journal Health Affairs.

"I am concerned that we will have this adoption gap where we have large systems that have health IT and small systems that don't if we don't address it on a policy basis," he said.

Standards, sure; money, maybe

Some private-sector experts in the health information field say federal involvement in the issue is long overdue and sorely needed. Medicare, for instance, has been slow to realize its potential in promoting EMRs and health IT to doctors, said Dan Mendelson of the health care consulting firm Avalere Health in Washington, D.C.

"As the largest single U.S. purchaser of health care services, Medicare has the power to promote physician adoption of health information technology," he said. "The Centers for Medicare & Medicaid Services should clarify its technology objectives, engage the physician community, shape the development of standards and technology certification criteria, and adopt concrete payment systems to promote adoption of meaningful technology that furthers the interests of Medicare beneficiaries."

On the first three of these recommendations, the panel that HHS convened likely will have a substantial effect on an industry poised to make great inroads in physician practices nationwide, Dr. Henley said. By establishing ground rules for EMRs and directing federal agencies and private firms alike to abide by them, the collaborative will enable hardware and software vendors to sell products that even the smaller practices will be interested in buying, he said.

But the prospect of robust government investment in startup funding is not nearly as high an expectation in the physician community.

"It's unlikely that the federal government or state governments are going to put a significant amount of money into financial incentives for physicians to purchase these products," Dr. Henley said. "As the vendor market kind of rediscovers the physician market after some of these other issues are addressed, prices will continue to improve, and physicians will see that that's an investment that one can make and recoup."

AHIC will hold its first public meeting Oct. 10 in Washington, D.C. More details about the commission are online (link).