“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”--President George W. Bush, State of the Union Address, January 20, 2004

President Bush has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. The President believes that better health information technology is essential to his vision of a health care system that puts the needs and the values of the patient first and gives patients information they need to make clinical and economic decisions – in consultation with dedicated health care professionals. This link details what President Bush has mandated regarding EHRs.

Framework 1

The first Framework goal is to inform clinical practices regarding EHRs.  In order to achieve this goal, Uncle Sam has moved quickly from pilot programs in a few states to a national program in which Centers for Medicare and Medicaid (CMS) are "helping educate" practices concerning EHR vendors, offering EHR consulting services and otherwise undertaking marketing efforts of many smaller vendors.  Sometimes Government actions are clearly not small vendor friendly. Unfortunately, some of the information and consulting services promote the same large-vendor "vaporware" products with little more than commitment from the vendor to keep their system current to "standards" whenever they are issued or evolved - which we believe is a hollow commitment.

Even the Certification Commission for Healthcare Information Technology (CCHIT - Which HIMSS and the feds created) seems to be going down a difficult path.  By developing validation standards (due July 2005) and then testing vendor systems to such standards (which may be minimal) they shed little light on whether what vendors claim about their systems is what they are actually delivering.  Instead, it might be wiser to simply and independently validate that what vendors offer to PGPs is what they deliver.  Validation of what is offered is a very different approach than validation to some watered down consensus of what vendors "should" offer as described in a consortium-developed "standard".

Framework 2

The second Framework goal is to interconnect clinicians to each other. Interoperability will provide for more open systems and generate a consistent method that multiple vendors can use to safely and securely distribute patient information among themselves and to the federal Government To implement such exchange, tow things must occur.  First, vendors must offer an EHR with connectivity to standards built-in, including the standards shown below.

Second, Regional Health Information Organizations(RHIOs) must be built to which EHR systems in group practices, hospitals, laboratories and other sectors of the healthcare industry can connect.  Once RHIOs are in place, they will be connected into one, integrated national health information network that will be coordinated by federal health intermediaries throughout the country.  In this sense, RHIOs are little more than a dusted-off, updated version of the Community Health Information Networks (CHINs) that failed miserably a decade and a half ago during the first Clinton Administration era.  So why will they succeed this time around?

For one thing, there is now ubiquitous Internet and the embryonic Internet-2.  There is also supposed to be federal money (although physician group practices have not seen a lot of this so far). In addition, the work of standards organizations is much further evolved and organizations like IHE (Inter grating the Healthcare Enterprise) are actually making these interoperability standards work.  Finally, there is a strong emphasis on both cost reduction and improvement in quality of care.  As a result, the RHIOs being advocated today have a better chance of actually happening than the CHINs of a decade ago.

RHIOs are now searching to find services that are actually of value to PGPs (something that CHINs never did); but what such services might be is still being determined by the existing RHIOs. At the same time, large vendors like Cerner (Kansas City) and others are looking to create (and control) RHIO implementations around the country.  To entice PGPs to adopt EHRs in any significant way, strategies must be created that provide value in the patient care processes that affect practices on a daily basis.  

Framework 3

Framework 4

The final goal is to improve population health by gathering, analyzing and distributing up-to-date outcomes information affecting public health.  Hopefully this will encourage the healthcare industry and educated patients to achieve a more automated process that accelerates an evidence-based clinical practice of medicine, thus minimizing quality variations and achieving better overall outcomes.

One way of doing this is by publishing "report cards" on various healthcare providers, including health systems, individual hospitals and even group practices.  Report cards on specific providers are becoming more widely available, however the average consumer has no idea they exist or where or how to access this public information.

According to David Brailer, MD, PhD, national coordinator for health information technology, one of three strategies for achieving the goal of interconnecting care is fostering regional collaboration. Regional collaborations, termed regional health information organizations (RHIOs), are multi stakeholder organizations working together to connect healthcare communities with the goal of improving quality of care, safety, and efficiency. This article from AHIMA highlights the NY state RHIO initiative.

Doctors' Office Quality Information Technology (DOQ-IT -- pronounced docket) is a Medicare-funded project to assist small and medium- sized practices in implementing the use of EHRs. During the current pilot phase of the project, OMPRO (a nonprofit organization dedicated to improving the quality and effectiveness of healthcare) is working with medical practices currently implementing EHRs.

All state QIOs who are charged with working with 5% of all group practices adopting EHR have available to them the MSP EHR Selector tool (at www.ehrselector.com) which allows them to provide an impartial comparison based on partially vetted data, using 375 user-selectable criteria and EHR features, and to learn why EACH is important in the EHR selection process. These have been picked from the MSP EHR Benchmark of over 2,100 features on 104 different EHR systems.

Federal officials have taken several steps in recent weeks (August 2005) to further encourage the adoption of health information technology. The Department of Health and Human Services, for instance, announced its intention to soon publish two proposed rules that would start to lift regulatory barriers that prevent hospitals and other organizations from helping physicians adopt I.T. This article from Health Data Management details the recent happenings.