Qual-IT - May 2006 | Archived

Efforts to encourage widespread adoption of health information technology (HIT) are not new. Several organizations across the country have pioneered the development and use of electronic health information within specific health care settings, and public health agencies have developed large-scale automated systems to collect and analyze their data. Starting in 1999, the Institute of Medicine's series of landmark reports on patient safety and quality built a compelling case for HIT. 

Despite these impressive antecedents, there is no question that 2004 was a landmark year in establishing the national vision and leadership needed to spur widespread and coordinated actions to promote HIT. In April, the President issued an executive order setting a national goal for the use of electronic medical records and creating the position of national HIT coordinator to promote this agenda. By July, HHS responded with its strategic plan, which calls for building the HIT infrastructure as well as promoting communication across the health care system through a national health information network. The plan also underscores the need for collaborative efforts to promote HIT adoption and use by establishing agreements for information exchange across disparate systems, as well as mechanisms to share HIT costs and benefits.

While recognizing that this is a long-term process, clearly establishing these goals and principles as national priorities and providing ongoing leadership coordination through HHS have undoubtedly placed HIT high on the agenda for sustained change.  

That such high-level attention was needed speaks to the scope and complexity of the barriers to HIT's widespread adoption and use. While technology has provided health care with many new diagnostic, clinical, and research tools, the health care sector lags in its adoption of technology for basic operational purposes, let alone for improving quality, safety, and efficiency. Costs are widely viewed as a barrier, reflecting both short-term (lack of capital) and long-term (absence of return on investment models) concerns. HHS initiatives have stimulated academic and practical efforts to link HIT financing and implementation efforts, but the federal government's funding of these activities remains very limited.

The absence of standards for HIT products adds risk to expenditure decisions, since basic functional specifications, as well as data communication standards, vary widely across the existing tools. Major trade-offs need to be reconciled between higher levels of functions and detail, on the one hand, and mitigating the costs for new products and retrofitting existing systems on the other. HHS has promoted new standards development efforts since 2004. But while the need for standards has been a topic of discussion for many years, neither government nor the private sector has mustered sufficient clout or consensus to move forward decisively. 

HHS's plan also made an important contribution by advancing multi-stakeholder collaboration at the regional level as a driving force to promote HIT adoption and use. As the plan concludes:

“The development, implementation, and application of secure health information exchange
across care settings requires a local leadership, oversight, fiduciary responsibility,
and governance. These regional health information organizations (RHIOs) are critical
to health information exchange that reflects the health care priorities of a local area as well
as the legitimacy and trustworthiness of this activity to clinicians and consumers.”
(HHS Strategic Plan, p.17)

Such regional organizations have proliferated since the issuance of the plan, despite the lack of common standards for the organizations themselves or for the information exchange policies and tools they would use. Although the plan did not specify how the activities of these RHIOs would be coordinated, state governments started to express a greater interest in advancing HIT implementation and, to varying degrees, coordinating efforts to establish regional and statewide health information interoperability. HHS is now evaluating the policy implications of the state role as part of the national HIT strategy, through a study to be conducted by the American Health Information Management Association. Setting aside the question of where this coordination should take place, the concept of multi-stakeholder collaboration has been widely adopted as a principle for organizing HIT interoperability efforts. The success of these partnerships will be an important part of Dr. Brailer's legacy.

American Health Information Management Association study information is available online at www.staterhio.org

HHS Strategic Plan is available online at www.hhs.gov/healthit