Qual-IT - June 2005 | Archived

By setting a goal of creating electronic health records for all Americans within the next ten years, a 2004 executive order issued by President Bush has spurred a wide variety of activities within and outside of the federal government.  A national coordinator for health information technology, Dr. David Brailer, was appointed and charged with formulating and executing policies to advance this goal, while ensuring that electronic health information can be accessed and exchanged within and across health care settings.  Health and Human Services (HHS) Secretary Leavitt has also indicated that health information technology is one of his top priorities. 

Last year also saw the convening, by HHS, of a Health Information Technology Leadership Panel, comprising senior executives from Fortune 500 companies with experience in using IT to enhance their business practices.  In its recently issued report the panel cited three key imperatives for health information technology:

• Widespread adoption of interoperable health information systems should be a top priority for the U.S. health care system;
• The federal government should use its leverage as a payer and provider to drive HIT adoption; and
• Private-sector collaborations should align with these federal efforts.

Following up on this report, on June 6 Secretary Leavitt announced the formation of a new national organization comprising various health care stakeholder interests.  The new group, America's Health Information Community, is charged with providing recommendations on how to accelerate the adoption of health information technology, through measures to protect privacy and security; priorities for HIT based on consumer benefit; processes to develop and harmonize interoperability standards and certify HIT products based on those standards; a national web-based architecture to facilitate data exchange; and a transition, within five years, to private-sector governance for these activities.

On June 7, HHS published a request for proposals from public and private entities to address the key components of the national HIT agenda, as described by the Secretary.  Selected contractors will develop prototypes for a web-based national health information network architecture; document required functions for electronic health records, and develop certification criteria and compliance processes for these products; harmonize HIT standards to ensure interoperability across health information systems; and/or propose standardized privacy and security requirements, taking into account current federal and state laws.  Through this solicitation, HHS has established the future direction of the national HIT policy agenda, creating a “market structure” through which “vendors and providers will begin to innovate and bring the needed efficiencies and services” (Department of Health and Human Services 2005).

In Congress, Reps. Tim Murphy (R-PA) and Patrick Kennedy (D-RI) recently introduced HR 2234, the 21^st Century Health Information Act of 2005, which received widespread bipartisan support, including that of Sen. Hillary Rodham Clinton (D-NY) and former House Speaker Newt Gingrich.  The primary focus of this legislation is creation of a framework for, and provision of several federal funding opportunities to promote, the development of regional health information organizations (RHIOs).   While RHIOs no longer figure prominently in the HHS plan, there are some features common to that plan and this proposed legislation.  Among its key provisions:

• Up to 20 three-year grants would be provided to support RHIO development, contingent on each RHIO's submission, within one year, of a plan to establish networks for electronic health information sharing among providers, provide consumers with access to their personal health information, ensure that interoperability and privacy requirements are met, and demonstrate improvements in quality and safety, including performance measurement information based on National Quality Forum-endorsed measures.
• Federal funding would be available for RHIOs meeting future HHS accreditation standards, and for their participating providers.  Medicare would provide additional payments for providers participating in an accredited RHIO and using health information technology products and applications (such as electronic prescribing) that improve clinical quality.  Current Medicare policies would be amended to provide a safe harbor for financial and technology arrangements between and among hospitals and physicians, to advance regional health information infrastructure and data exchange activities; similarly, these funding or equipment arrangements would be exempt from physician self-referral limits.  Federal matching funds would be provided to state Medicaid programs for expenditures related to establishing RHIOs and assisting community health centers and other Medicaid providers to acquire health information technology.  And, finally, federal loan assistance would be made available to accredited RHIOs to finance investments in developing network infrastructure, acquiring technology, and providing training to assist physicians' practices.
• A national technical assistance center, to be established by the Agency for Healthcare Research and Quality, would help physicians (particularly those in small practices) adopt health information technology and participate in RHIOs.  The center would develop a clearinghouse of best practices, guidelines, and implementation strategies, as well as a change management toolkit to address clinical workflow, vendor selection, and technology implementation issues.  HHS would also provide technical assistance regarding the formation of RHIOs.
• Health information technology products (such as electronic medical records) used in conjunction with these activities would be required to comply with interoperability data standards and compliance criteria.  The standards, and the certification and compliance process, would be established by a recognized national standards-setting organization or by HHS if that organization has not yet been established or the standards not yet finalized.

Several other pieces of legislation will be filed in the coming weeks, and we will continue to provide updates in future editions of Qual-IT.

Department of Health and Human Services.  Fact sheet: American Health Information Community.  June 2005.  Available online at http://www.hhs.gov/healthit/documents/FactSheet-AHIC.pdf  [link launches pdf file]

e-Health Initiative.  Parallel pathways for quality healthcare: A framework for aligning incentives with quality and health information technology.  May 2005. Available online at http://www.ehealthinitiative.org/assets/documents/ParallelPathway5-25-052PM.doc

Government Accountability Office.  Health information technology: HHS is taking steps to develop a national strategy.  May 2005.  Available online at http://www.gao.gov/new.items/d05628.pdf [link launches pdf file]

Health Information Technology Leadership Panel. Final report. May 2005. Available online at http://www.hhs.gov/healthit/HITFinalReport.pdf [link launches pdf file]

U.S. Congress. House. The 21^st Century Health Information Act of 2005. HR 2234.  109^th Cong., 1^st sess.  May 10, 2005.  Available online at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_bills&docid=f:h2234ih.txt.pdf [link launches pdf file]

These HHS and legislative actions illustrate basic elements of an emerging federal health information technology policy.  Further, the Government Accountability Office (GAO) has just published a report cataloging the activities of various federal agencies to advance HIT adoption and use.  The report identifies four key elements of a successful HIT strategy, based on experience in the U.S. and abroad: endorsement by high-level leadership; definition and adoption of standards; broad stakeholder input; and deployment of HIT solutions in small increments. As described above, HHS and Congress are both taking steps to incorporate these elements.

Clearly, there is agreement at this stage that national standards are required to ensure that health information technology will be interoperable, facilitating broad data exchange among health care providers and consumers.  Agreements and mechanisms for data exchange will need to conform to basic requirements, including those regarding privacy and security protections.

One key area that is not addressed through the HHS plan is financing.  A combination of financing methods will be needed to promote the adoption and use of the requisite health information technology tools.  As advanced by Reps. Murphy and Kennedy, information technology could be a catalyst for Medicare payment incentives, which would affect a large number of health care providers and beneficiaries.  Additional bills will soon be introduced advancing alternative models for HIT financing.

For the short term, federal funding for health information technology will be modest, and competition for those funds will be stiff.  Payers (including Medicare) have not yet made substantial commitments to payment incentives to directly support or leverage information technology.  The Murphy/Kennedy legislation explicitly recognizes that physician adoption is an important factor; major resources will be required to provide the direct, sustained support for physician practices that will be required to make that happen, especially training for administrative and clinical personnel.

The growing national emphasis and focus on standards development and adoption will greatly benefit statewide and regional efforts to promote interoperability among health information systems.  But we cannot wait for that process to be completed before mapping the strategic direction for health information technology in New York.

We can begin to lay the foundation by establishing priorities for investment in health information systems infrastructure, and by defining the respective roles of state government and local voluntary efforts to promote health information technology adoption and use.  Allocation of HEAL-NY (Health Efficiency and Affordability Law for New Yorkers) funding is an important first step in this long-term process.

We also need to engage payers, employers, providers, and consumers in developing business models that will promote and sustain the use of information technology to improve health care quality, safety, and efficiency.  Recommendations for such an approach – via linkage of quality incentives with physician adoption of HIT and the development of infrastructure for data exchange – were unveiled, recently, by the eHealth Initiative, in its Parallel Pathways for Quality Health Care report.  We also must promote rapid testing, adoption, and dissemination of proven strategies and tools to foster interoperable health information data exchange.

The advance of federal policies in this area will bring greater shape and clarity to the national agenda, but it is clear that state and regional efforts will play a crucial role in driving grassroots implementation of health information technology. The United Hospital Fund will continue to advance policy development and implementation activities to support HIT adoption and use in New York.  Future issues of Qual-IT will report on those efforts.

Priorities for HIT Interoperability