In the last week or so a lot of commentary on what Health IT programmes should be sponsored and funded as part of the Economic Stimulus Package has been forthcoming. (The package is rumoured to be valued overall at up to $1 trillion –
Some of the better commentary is found in the following articles.
Electronic Records Are Key to Health-Care Reform
BusinessWeek reader William Yasnoff says Obama must make electronic medical records a top priority in his economic stimulus plan
William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm.
The current worldwide financial crisis is transforming the problem of rising U.S. health-care costs into a dire threat to our entire economy, making health-care reform an increasingly urgent priority. Any potential approach to restructuring health care must include universal electronic medical records so that both patient care and policy decisions are fully informed. In his weekly address to the nation on Dec. 6, President-elect Barack Obama made a commitment to this goal as part of his economic recovery plan. But what exactly needs to be done to achieve this?
Today, each person's medical records are scattered among all the places where care has been given—leaving no one with a complete copy. Amazingly, no health-care institutions are responsible for ensuring that complete records are available for each person when care is needed. As the President-elect stated, both the quality and safety of health care could be greatly improved if complete electronic medical records were immediately available to physicians. Efficiency would also increase through, for example, the elimination of unnecessary duplicate tests and imaging procedures. Of course, any system of electronic medical records requires stringent privacy protections to prevent unauthorized access or use.
Health record banks can address our health information needs by providing each person with an electronic "account" where copies of all their medical records could be deposited, stored, and retrieved. A health record bank account would operate much like today's familiar checking account. But instead of depositing money, your medical providers would deposit copies of your new records after each care episode (which they must do at your request under the Health Insurance Portability & Accountability Act, or HIPAA).
Privacy First
Just as you control the funds in your checking account, you would retain sole authority over access to any portion of your medical records in a health record bank. Normally, you would make the complete records available to your own doctors and to health-care personnel treating you in an emergency. You would have access to your records yourself (including the ability to add information if you wished) and would be able to see exactly who else has accessed your records and when. With your permission, your information could be aggregated with others' data into anonymized reports for public health officials, medical researchers, and policymakers.
Health record banks would be required to protect your privacy by guaranteeing that you fully control who sees any portion of your records, and to safeguard your information using the same computer security techniques applied today to protect classified military information. There would also be regular independent privacy and security audits (analogous to auditing requirements for financial banks). Health record banks would be privately financed, owned, and operated, and governed either by community nonprofits or via regulation. Multiple competitive health record banks are entirely feasible to provide choices for consumers.
A health record bank account would cost no more than $1 per month—and the health-care savings from the availability of the information would be many times that amount! Some employers may elect to cover this cost as part of their health plan, particularly for beneficiaries with chronic diseases where improvements in quality of care and cost savings from having complete electronic medical records would be even more substantial and immediate.
Much more here:
http://www.businessweek.com/bwdaily/dnflash/content/dec2008/db20081218_385824.htm
We also have a useful review from iHealthBeat on what the drivers of investment are..
Industry Predictions: What Are the Drivers Shaping Health Care IT in 2009?
"If we want to overcome our economic challenges, then we must finally address our health care challenge."
-President-elect Barack Obama
So said the next president of the United States during a press conference where he introduced Tom Daschle as the next HHS secretary, as well as a new post -- head of the White House Office of Health Reform.
Health IT has gone mainstream. It's beyond hospital CIOs' offices, inside-Beltway legislation, and presidential candidate promises. Kaiser Permanente placed an ad in November 2008 titled, "Unleashing the Power of Connectivity in Health Care." The ad wasn't in a health trade journal; it was in The New Yorker magazine.
2009 will be a crossroads kind of year for health IT. Welcome to my annual iHealthBeat end-of-the-year column providing a look forward at health IT. The drivers shaping health IT in 2009 are bound up in one major "uber-uncertainty" facing the nation: that is, the macroeconomy and how it affects business, the financial markets, government agencies at both the federal and state level, citizens ... and the health microeconomy.
Health Is Part of Larger Macroeconomy
What's become clearer for the forecast is that Obama views health as part of the larger economy. He made that clear in the above statement and elsewhere on the campaign trail and during several public appearances since winning the election. A stimulus package might not embrace the flagging automobile industry, but it most assuredly will have specific components targeting health care and IT.
Team Obama views investment in health IT as an investment in the U.S. infrastructure -- a major focus of the economic stimulus platform. Obama wants his administration to spend $10 billion a year in grants and tax incentives on health IT initiatives over the next five years.
The main effort will be to help providers adopt health IT with the express goal of improving patient outcomes. The promise of funding is not only for technology itself, but for technical assistance in implementing electronic health records and financial systems. One specific number has been mentioned: that those physicians who meet standards could be eligible for up to $40,000 over five years. Hospital providers would qualify for even higher levels of subsidy.
Furthermore, there are plans for standards to get interoperability, privacy and security finalized. There's also talk about making open source software available at nominal cost to providers.
The economic stimulus rationale for investing in health care was put this way by the Obama team: "pouring billions of dollars into an array of health programs will not only boost the economy but also make a down payment on promises of broader health care reform."
More here:
MORE ON THE WEB
We also have warnings of the potential for waste:
Letter highlights hurdles in digitizing health records
Specialists tell Obama current systems flawed
WASHINGTON - As Barack Obama prepares to spend billions on health information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems.
In a recent open letter to the president-elect, a top technology adviser to the American Academy of Family Physicians said that current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.
"If America's physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the [tower of] Babel that already exists," wrote David Kibbe, a senior adviser to the academy and a longtime proponent of health information technology, and Bruce Klepper, a healthcare market analyst.
Kibbe and Klepper said some of the stimulus package could be spent on electronic health records, but the bulk of it should go toward simpler and cheaper technology, such as rewarding doctors for using computers to communicate with patients and for specialist referrals. The money should also help extend high-speed Internet access to doctors who don't have it, they wrote.
Obama and many health policy analysts support a large investment in electronic health records - powerful tools that contain a full account of a patient's health that can be shared with other doctors, made available to patients, and can advise doctors on the best therapies and warn them against errors - saying they will dramatically improve patient care and reduce healthcare costs. Even skeptics see them as an inevitable part of the future of medicine. But Kibbe and Klepper's letter highlights the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system.
There is no nationwide, secure computer network on which to send information. Electronic recordkeeping systems are expensive upfront and to maintain, and doctors often lose money on the investment. Significant privacy issues are unresolved, such as conflicting state privacy laws that complicate the sharing of information. Different kinds of recordkeeping systems do not mesh easily.
"It's immensely complicated," said Melissa Goldstein, a health policy professor at The George Washington University's School of Public Health and Health Services.
More here:
and finally from some serious heavy hitters about the need to ensure interoperability. See:
Connecting The Medical Dots
By Mike Leavitt
Monday, December 22, 2008; A21
Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.
Before lawmakers act, they need to think: If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed.
Health IT systems produce value when they are interoperable. When they're not, doctors who invest in electronic health records cannot share information with each other or add lab results to your file or send electronic prescriptions to your pharmacist. They would have to use handwritten prescriptions and paper files in addition to their electronic files.
That's not the way 21st-century health care should work. Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content -- such as patients' diagnoses, allergies, medications, lab tests and medical directives -- is standard for every patient, every time.
We're already on the road to a system that is universally accessible and secure. Health information experts, with coordination by the Department of Health and Human Services, have been working on foundational health IT standards and have made substantial progress. Congress has approved our request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5 million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number.
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If we're going to build a 21st-century health infrastructure, we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve the quality of health care overall.
The writer is U.S. secretary of health and human services.
More here:
http://www.washingtonpost.com/wp-dyn/content/article/2008/12/21/AR2008122101448.html
It is really good to see the sensible and serious discussion to try to ensure that the right plans are put in place and the right things done.
All very hopeful!
David.
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