HHS pushes electronic health records

Although the plan would cost $10B, it could save $170B annually

The Department of Health and Human Services today unveiled a 10-year plan to create a new national health information infrastructure (download PDF), including an electronic health record (EHR) for every American and a new network to link health records nationwide.

HHS Secretary Tommy Thompson said in a statement at the HHS Summit on Health Information Technology in Washington that "electronic health information will provide a quantum leap in patient power, doctor power and effective health care. We can't wait any longer."

Thompson estimated that adoption of EHR systems nationally could save 10% of the nation's current annual $1.7 trillion health care bill. He also said that EHRs would improve privacy, better protect medical records and decrease medical errors while reducing administrative costs. Patients would own and control access to their own medical records, he said.

Dr. Brent James, vice president for research at Intermountain Health Care in Salt Lake City, which currently maintains EHRs for 1 million patients, said he believes the savings from streamlining the health care system with EHR could eventually amount to $400 billion per year.

Trace Devanny, president of Cerner Corp., a health care IT vendor in North Kansas City, Mo., said the use of EHRs could cut costs from the health care system by providing doctors anywhere with access to information about any patient electronically. That would help eliminate duplicate tests and treatments when a patient visits an out-of-town physician and would improve the quality of care, Devanny said.

But generating those savings could come with a hefty price tag, according to Mike Kappel, senior vice president of strategic planning at McKesson Corp., a San Francisco-based health care IT vendor. Kappel said he "would not find it impossible to believe" that the cost for a national, networked EHR system could hit $10 billion.

According to Kappel, the U.S. government has budgeted only $50 million this year and $100 million next year for health care IT, meaning the costs associated with the new systems could be pushed out to doctors and hospitals, with the financial benefits flowing to health insurance companies.

David Barnhart, CIO at Wuesthoff Health System Inc. in Rockledge, Fla., agreed that health care providers will likely absorb the brunt of the costs and said that HHS needs to find a way to "incentivize" providers to embrace EHR. If insurers paid a premium to hospitals that take part in the new system, that would speed adoption, he said.

In its "Framework for Strategic Action" plan for health care IT, HHS recognized that it needs to provide such incentives. The plan said that the Centers for Medicare and Medicaid Services (CMS) is considering authorizing extra payments to doctors who use EHRs. CMS will also evaluate "pay for performance" EHR demonstration programs to boost adoption and will develop an Internet portal for Medicare beneficiaries to access personal medical information. HHS will also consider regional grants and low-cost loans to stimulate EHR use.

The HHS plan also calls for development of standards-based and certified EHR systems and networks. Today, three industry groups representing a wide range of providers, payers and vendors announced that they had established a collaborative initiative to certify EHRs. Those groups are the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS) and the National Alliance for Health Information Technology.

"We believe that voluntary, private-sector certification of these systems will let physicians and other health care professionals select and implement these products with greater speed and confidence, and ensure that information can be securely exchanged as the nation's health information infrastructure develops," Dr. Mark Leavitt, medical director of HIMSS, said in a statement.

Intermountain Health's James said that if the use of EHRs is to become routine, vendors will need to pay strict attention to standards; products that supposedly adhere to the Health Level 7 standard for data interchange don't always do so.

He also said that vendors need to work on EHR interfaces. "I can spend as much on the interface as [on] the software."

Given the importance of health care, it might be better for the National Bureau of Standards to set the standards and certification for EHRs rather than an industry group, James said.

Barnhart said vendors need to agree on basic issues such as how to represent blood pressure in an EHR. One vendor currently uses two fields, while another uses one. Terry Hsu, CIO at Evergreen Healthcare in Seattle, also called for better EHR user interfaces, saying those now in use "are not quite there yet."

James believes a nationwide EHR is achievable and said the savings are so compelling that it will be hard to derail. From his perspective, he said, the plan announced today will be "Tommy Thompson's legacy."

Copyright © 2004 IDG Communications, Inc.

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