A Powerful Lesson on How to do e-Health Properly.

The following appeared in the New England Journal of Medicine over the holidays.

Launching HITECH

Posted by NEJM • December 30th, 2009 • Printer-friendly

David Blumenthal, M.D., M.P.P.

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform at their best or deliver the highest-quality care, any more than an Olympian could excel with a failing heart. Yet the proportion of U.S. health care professionals and hospitals that have begun the transition to electronic health information systems is remarkably small.^1,2

On December 30, the government took several critical steps toward a nationwide, interoperable, private, and secure electronic health information system. The Department of Health and Human Services (DHHS) released two proposed regulations affecting HIT (www.healthit.hhs.gov and http://www.federalregister.gov/inspection.aspx#special). The first, a notice of proposed rule-making (NPRM), describes how hospitals, physicians, and other health care professionals can qualify for billions of dollars of extra Medicare and Medicaid payments through the meaningful use of electronic health records (EHRs). The second, an interim final regulation, describes the standards and certification criteria that those EHRs must meet for their users to collect the payments. In addition, between August and December 2009, my office — the DHHS Office of the National Coordinator for Health Information Technology (ONC) — announced nearly $2 billion worth of new programs to help providers become meaningful users of EHRs and to lay the groundwork for an advanced electronic health information system. All these actions were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009, also known as the stimulus bill (see table).³

The provisions of the HITECH Act are best understood not as investments in technology per se but as efforts to improve the health of Americans and the performance of their health care system. The installation of EHRs is an important first step. But EHRs will accomplish little unless providers use them to their full potential; unless health data can flow freely, privately, and securely to the places where they are needed; and unless HIT becomes increasingly capable and easy to use.

Understanding this, Congress and the Obama administration structured the HITECH Act so as to reward the meaningful use of qualified, certified EHRs — an innovative and powerful concept. By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a sufficient purpose: it is the use of EHRs to achieve health and efficiency goals that matters.

The effort to achieve meaningful use provides the best lens through which to understand the government’s actions in implementing the HITECH Act. The administration is trying to do four basic things: define meaningful use, encourage and support the attainment of meaningful use through incentives and grant programs, bolster public trust in electronic information systems by ensuring their privacy and security, and foster continued HIT innovation.

The full and detailed article is available (freely) here:

http://healthcarereform.nejm.org/?p=2669&query=TOC

For e-Health in the US, and by some considerable trickle down to us I suspect, this is the biggest and most important policy statement I have seen!

If the turkeys who run Australian e-Health had anything like some brains they would be reading closely and working out how they can use similar Government policy levers to achieve similar results.

It is really pretty much all here in my view. Incentives, incremental improvement, clinician driven and the list goes on.

We have wasted a decade and it has taken the Obama administration a little less than a year to legislate funds and start serious work.

It would be real fun to be in US Health IT right now.

Go read the article closely to see just how much is being done in all the right area (training, standards etc).

This is the biggest thing in e-Health since the UK Government launched Information for Health a decade ago and kicked off the National Program for Health IT. This is genuine e-Health history in the making I believe.

David.