Why open source is health reform February 2, 2010
Posted by gonzalezloumiet in NHIN, open source.Tags: Diabetes, Harvard, Indivo, NHIN, open source
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Posted by Dana Blankenhorn @ 7:41 am
Health reform, at its heart, is an effort to transform market incentives.
In the current system, there is no reason to limit costs. The doctor who diagnoses an illness directs treatment. The more treatment, the more money is made by the hospital and its supply chain.
Payment is similarly disconnected from service. Insurers have tried, for years, to fight these cost rises on behalf of their customers, and failed.
Open source starts by connecting data. As Matt Mattox of Axial observed last week (talking with Jason Hibbets of Red Hat), it drives systems toward an open architecture.
The current Administration’s support for open source and open architectures is aimed at breaking apart data silos, collecting the data that can in turn drive change.
The fear of the Administration’s opponents is that government will control the data. But another important aspect of open source health care is that it can give patients access to their own data.
That’s the aim of Indivo, a new open source project from, among others the Harvard Medical School, the same people who are driving the Administration’s health reform proposals.
As Fred Trotter explains, it’s a Personal Health Record (PHR) platform engine. It’s both a way to make a PHR, and link PHRs together. It’s a way to break the silos being created in that market, much as the NHIN “Health Internet” is designed to break silos in the larger Electronic Health Record (EHR) market.
We should already have enough data to drive reform. We know what works. Wellness services work. Doing what is cost-effective first works. Every other industrial nation has used these tools to transform incentives and provide ample care at a fraction of the cost Americans pay.
But by making political arguments against science, those who benefit from current business models have succeeded, for now, in preventing reform.
So thousands of people will die needlessly this month, and next month, and the next, because they did not get needed care. And half those with diabetes will be reluctant to get treatment, for fear of losing their jobs and thus access to care.
My point is that these arguments may hold against the rivulets of data we now have available. By automating care under open source standards we can unleash a Google-sized torrent onto the research community, proving the case once and for all. By providing data to patients, we also empower them to demand change, and to seek services before they’re sick.
That’s why open source is health reform. Unlock a high enough flood of data and mere arguments will be blown away. Show people their own data, explain what it means, and people will demand the services needed in order to live and not just get well.
Source: http://healthcare.zdnet.com/?p=3273&alertspromo=&tag=nl.rSINGLE
Connect upgrades patient search, authentication January 26, 2010
Posted by gonzalezloumiet in Connect, Nationwide Health Information Network, Vish Sankaran.Tags: Connect, NHIN, Vish Sankaran
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By Mary Mosquera
Friday, January 22, 2010
The Health & Human Services Department has updated the government’s Connect software to incorporate the ability to query for a patient and to assure the identity of sender and recipient in the exchange of health data.
Connect is the federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that comprise the nationwide health information network (NHIN).
HHS continues to improve or add more functionality to the Connect gateway software on a quarterly basis to be a model for health information exchange, according to Les Westberg, Connect’s technical lead in the Federal Health Architecture (FHA) program and an executive with Agilex.
Authentication requirements “should be in line with some of the tightest security that’s possible right now,” he said, during an online conference Jan. 19 about the latest version of Connect software.
Authentication works hand-in-hand with the data use and reciprocal agreement (DURSA), which is a legal agreement signed by the organizations to assure a certain level of authentication, he said. The organizations communicate that authentication information with use of Security Assertion Mark-up Language (SAML), a standard for exchanging authentication and authorization data.
NHIN authentication services will include digital certificates to document a user’s identity has been verified, lists of those whose certification has been revoked and the ability to ask if an organization’s NHIN certification is still valid, Westberg said.
Another significant upgrade is the technical ability for Connect to be able to query if a patient is known to an exchange user. Some demographic data can accompany the query. That replaced a general notification that the system was looking for the subject, he said.
Connect also introduced a set of responses when a patient is discovered. The gateway can pass through the results of the discovery to the adapter, the interface between the healthcare organization and Connect; check the demographics first against a master patient index before passing through the information; or return the result and make a record of it
The FHA team revises Connect based on technical recommendations from the NHIN Specifications Factory, which is made up of representatives of the Office of the Nationa Coordinator for Health IT (ONC) and other public and private sectors involved in health information exchange. The NHIN requirements align with the latest Health IT Standards Panel and health information exchange standards, Westberg said.
HIT Policy Committee considers NHIN’s new role January 15, 2010
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January 15, 2010 | Diana Manos, Senior Editor
WASHINGTON – Members of the HIT Policy Committee wrestled with the fate of the Nationwide Health Information Network during their meeting on Wednesday.
Committee members said the NHIN, a federal interoperability initiative begun in 2004, must now align itself with the newer and more urgent timeline established in the HITECH part of the American Recovery and Reinvestment Act, passed last February.
The HIT Policy Committee adopted the NHIN workgroup’s recommendation for a "conceptual" framework for the NIHN and what the NHIN should expect from federal agencies. The members don’t know how those recommendations will be turned into actions and deadlines.
David Blumenthal, the National Coordinator for Health IT and chairman of the HIT Policy Committee, said the group will continue to expand its vision for the NHIN at upcoming meetings.
"The NHIN was developed before HITECH," he noted. "Is this sufficient, or should we be thinking more broadly?"
Blumenthal urged the committee to think of ways the government can promote meaningful use as part of the NHIN.
With providers who want to receive bonuses under ARRA expected to demonstrate meaningful use of healthcare IT by 2011, Blumenthal said of the NHIN: "If there are new investments we have to make, new aspirations we need to communicate, we have no time to lose."
The NHIN workgroup chairman, David Lansky, said the NHIN should enable the broadest range of providers to exchange information to achieve meaningful use and enable consumers to be able to access their health information. It should also provide access to states and other organizations that support providers.
The goals the committee approved for the future of the NHIN include:
- The federal government should focus on the minimum standards, policies and services needed for foundational exchange components to further meaningful use in the near-term.
- NHIN policies, standards and services should be structured so that intermediaries can provide required services for private and secure routing of health information.
- The federal government should work with stakeholders to improve and leverage directories for the NHIN.
- The federal government should define a core set of policies for the interoperation of trusted directories.
- The NHIN should build upon existing federal standards, policies and practices for authentication and identity proofing.
Uber Operations and NHIN: http://blog.uberops.com/2009/06/15/uber-operations-at-the-lista-d-c-forum/ and http://blog.uberops.com/2009/12/12/uberops-at-the-lista-2009-tech-leadership-summit/
Source: http://www.healthcareitnews.com/news/hit-policy-committee-considers-nhins-new-role
Keeping a SHARP Focus on Innovation December 18, 2009
Posted by gonzalezloumiet in Blumenthal.Tags: Blumenthal, SHARP
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Keeping a SHARP Focus on Innovation
December 18, 2009
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
Today the Obama administration announced the availability of $60 million in Recovery Act funds to support the development of the Strategic Health IT Advanced Research Projects (SHARP) program. SHARP awards will fund research focused on identifying technology solutions to address well-documented problems impeding broad adoption of health information technology (health IT). By helping to overcome key challenges, the research will also accelerate progress towards achieving nationwide meaningful use of health IT.
As we continue this unprecedented effort towards meaningful use and seamless, secure information exchange, we also must acknowledge that there remains a gap between the promise of health IT and the realization of its full benefits. To achieve the goal of a transformed health care delivery system, it’s critical that we close this gap by enabling a robust research infrastructure that can focus on areas where “breakthrough” advances are needed to help clear obstacles to adoption. Under the SHARP program, four awardees will receive funding to develop multidisciplinary research projects that will identify such breakthrough solutions.
SHARP program awardees will create research programs that draw from many areas of expertise. They will focus on issues of central interest to all health IT stakeholders, fostering considerable discussion and debate. If for example, SHARP research helped identify new methods to create tools that will, through their incorporation into deployed technology, enhance data security, then public trust in the electronic maintenance and exchange of health information would be reinforced and strengthened – which would in turn help encourage broader adoption.
Areas requiring this innovative research approach that will be tackled by the SHARP awardees include the security of health IT, patient-centered cognitive support, application and network platform architectures, and the secondary use of EHR data as a way of measuring and improving quality of care.
Another important aspect of the SHARP program is that the research projects will bring together key stakeholders – researchers, patient groups, health care providers, and others – to work with one another to transform health IT research into applications. This collaborative approach allows us to consider the many voices of health IT stakeholders, and work together towards common goals. With our eyes on the vision of patient-centered, quality health care we can focus research on innovative, pragmatic, and realistic solutions which can then be implemented across the nation.
I truly look forward to seeing the innovative research that emerges from this program. I know that this research will provide critical insights that will bring us closer every day to a better, more efficient health care delivery system, enabled by health IT and empowered by the seamless and secure exchange of electronic health information.
Sincerely,
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services
The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.
ONC reorganizes for push on EHR, HITECH goals December 3, 2009
Posted by gonzalezloumiet in HHS.Tags: HHS, HITECH
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Organization, Functions, and Delegations of Authority; Office of
the National Coordinator for Health Information Technology
AGENCY: Office of the Secretary, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: Statement of Organization, Functions, and Delegations of
Authority The Office of the National Coordinator for Health Information
Technology has reorganized its substructure components in order to more
effectively meet the mission outlined by The Health Information
Technology for Economic and Clinical Health (HITECH) Act, part of the
American Recovery and Reinvestment Act of 2009 (ARRA). The
reorganization affects all four of the original Director-level offices:
the Office of Health Information Technology Adoption (OHITA); the
Office of Interoperability and Standards (OIS); Office of Programs and
Coordination (OPC); and the Office of Policy and Research (OPR). The
new organizational structure is composed of five offices with direct
reporting capability to the National Coordinator for Health Information
Technology (National Coordinator): the Office of Economic Modeling and
Analysis; the Office of the Chief Scientist; the Office of the Deputy
National Coordinator for Programs & Policy; the Office of the Deputy
National Coordinator for Operations, and the Office of the Chief
Privacy Officer.
FOR FURTHER INFORMATION CONTACT: Marc Weisman, Office of the National
Coordinator, Office of the Secretary, 200 Independence Ave., NW.,
Washington, DC 20201, 202-690-6285.
Part A, Office of the Secretary, Statement of Organization,
Functions, and Delegations of Authority for the Department of Health
and Human Services, Part A, as last amended at 70 FR 48718-48720, dated
August 19, 2005, is amended to reflect the restructuring of the Office
of the National Coordinator for Health Information Technology (ONC) as
follows:
I. Under Part A, Chapter AR, Office of the National Coordinator for
Health Information Technology delete, ``Section AR.10 Organization,''
in its entirety and replace with the following:
Section AR.10 Organization. The Office of the National Coordinator
for Health Information Technology (ONC) is under the direction of the
National Coordinator for Health Information Technology who reports
directly to the Secretary. The office consists of the following
components:
A. Immediate Office of the National Coordinator (ARA)
B. Office of Economic Modeling and Analysis (ARB)
C. Office of the Chief Scientist (ARC)
D. Office of the Deputy National Coordinator For Programs & Policy
(ARD)
E. Office of the Deputy National Coordinator For Operations (ARE)
F. Office of the Chief Privacy Officer (ARF)
II. Under Part A, Chapter AR, Office of the National Coordinator
for Health Information Technology, Section AR.20 Functions, Chapter B,
delete, ``Office of the Health Information Technology Adoption (ARB),''
in its entirety and replace with the following:
B. Office of Economic Modeling and Analysis (ARB): The Office of
Economic Modeling and Analysis works with and reports directly to the
National Coordinator. The Office: (1) Applies advanced mathematical or
quantitative modeling to the U.S. health care system for simulating the
microeconomic and macroeconomic effects of investing in health
information technology and (2) provides advanced policy analysis of
health information technology strategies and policies to the National
Coordinator. Such modeling will be used with varying public policy
scenarios to perform advanced health care policy analysis for
requirements of the Recovery Act, such as reductions in health care
costs resulting from adoption and use of health information technology.
The results of these analyses provided to the National Coordinator will
inform strategies to enhance the use of health information technology
in improving the quality and efficiency of health care and improving
public health.
III. Under Part A, Chapter AR, Office of the National Coordinator
for Health Information Technology, Section AR.20 Functions, Chapter C,
delete, ``Office of Interoperability and Standards (ARC),'' in its
entirety and replace with the following:
C. Office of the Chief Scientist (ARC): The Office of the Chief
Scientist is headed by the Chief Scientist. The Office of the Chief
Scientist is responsible for: (1) Applying research methodologies to
perform evaluation studies of health information technology grant
programs; (2) identifying, tracking and supporting innovations in
health information technology; (3) leading research activities mandated
under the HITECH Act provisions of ARRA; (4) promoting applications of
health information technology that support basic and clinical research;
(5) collecting and communicating knowledge of health care informatics
from and to international audiences; (6) collaborating with other
agencies and departments on assessments of new health information
technology programs; and (7) developing and maintaining educational
programs for staff of the Office of the National Coordinator and
advising the National Coordinator concerning the educational needs of
the field of HIT. The Office of the Chief Scientist possesses and
utilizes specialized knowledge of medical bioinformatics, which
involves the study and application of advanced information methods and
technologies in support of health care and population health.
IV. Under Part A, Chapter AR, Office of the National Coordinator
for Health Information Technology, Section AR.20 Functions, Chapter D,
delete, ``Office of Programs and Coordination (ARE),'' in its entirety
and replace with the following:
D. Office of the Deputy National Coordinator for Programs & Policy
(ARD): The Office of the Deputy National Coordinator for Programs &
Policy is headed by the Deputy National Coordinator for Programs &
Policy. The Office of the Deputy National Coordinator for Programs &
Policy is responsible for: (1) Implementing and overseeing grant
programs that advance the nation toward universal meaningful use of
interoperable health information technology in support of health care
and population health; (2) coordinating among HHS agencies and offices
and among relevant executive branch agencies and the public health
information technology programs and policies to avoid duplication of
efforts and inconsistent activities; (3) developing the mechanisms for
establishing and implementing standards necessary for nationwide health
information exchange; (4)
[[Page 62786]]
formulating policy for the privacy and security of health information;
(5) developing policies as may be otherwise necessary for implementing
its mission; and (6) maintaining a Federal Health IT Strategic Plan.
V. Under Part A, Chapter AR, Office of the National Coordinator for
Health Information Technology, Section AR.20 Functions, Chapter E,
delete, ``Office of Policy and Research (ARF),'' in its entirety and
replace with the following:
E. Office of the Deputy National Coordinator for Operations (ARE):
The Office of the Deputy National Coordinator for Operations is headed
by the Deputy National Coordinator for Operations. The Office of the
Deputy National Coordinator for Operations is responsible for
performing the activities that support the Office of the National
Coordinator for Health Information Technology's numerous programs.
These include: (1) Budget formulation and execution; (2) contracts and
grants management; (3) facilities management; (4) human resources; (5)
stakeholder communications; and (6) financial and human capital
strategic planning.
VI. Under Part A, Chapter AR, Office of the National Coordinator
for Health Information Technology, Section AR.20 Functions, immediately
following Chapter E, insert the following:
F. Office of the Chief Privacy Officer (ARF): The Office of the
Chief Privacy Officer is headed by the Chief Privacy Officer, who
advises the National Coordinator as directed by the ARRA. The Chief
Privacy Officer may also report to other individuals, as necessary. The
Chief Privacy Officer of the Office of the National Coordinator for
Health Information Technology will be appointed by the Secretary. The
Office of the Chief Privacy Officer is responsible for: (1) advising
the National Coordinator on privacy, security, and data stewardship of
electronic health information and (2) coordinating the Office of the
National Coordinator for Health Information Technology's efforts with
similar privacy officers in other Federal agencies, State and regional
agencies, and foreign countries with regard to the privacy, security,
and data stewardship of electronic, individually identifiable health
information.
VII. Delegation of Authority. Pending further delegation,
directives or orders by the Secretary or by the National Coordinator
for Health Information Technology, all delegations and redelegations of
authority made to officials and employees of affected organizational
components will continue in them or their successors pending further
redelegations, provided they are consistent with this reorganization.
Authority: 44 U.S.C. 3101.
Dated: November 20, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9-28755 Filed 11-30-09; 8:45 am]
BILLING CODE 4150-24-P
Beacon Communities: Shining a Light on the Real Impacts of Health IT December 2, 2009
Posted by gonzalezloumiet in Blumenthal, HHS.Tags: Beacon Community Program, Blumenthal, HHS
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Beacon Communities: Shining a Light on the Real Impacts of Health IT
December 2, 2009
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
Today the administration announced the availability of $235 million in funds to support the Beacon Community Program. The Beacon Community Program (BCP) will help to accelerate and demonstrate the ability of health IT to transform local health care systems, and to improve the lives of Americans and the performance of the health care providers who serve them. The Program will take communities at the cutting edge of electronic health record (EHR) adoption and health information exchange and push them to a new level of health care quality and efficiency. The resulting experience will inform efforts throughout the United States to support the meaningful use of EHRs, the primary goal of the Federal Government’s new health IT initiative.
$220M of the funds will support 15 communities, which are expected to have rates of EHR adoption that are significantly higher than published national estimates. These communities are best positioned to lead the way in accomplishing meaningful use of EHRs and to provide valuable lessons to other localities on the preferred approaches to elevating the performance of local health systems using health IT. An additional $15 million will subsequently support technical assistance to the communities and an independent evaluation of the program.
As part of the $220 million in cooperative agreements that will support the 15 chosen communities, recipients will be asked to define, track, and report on progress toward concrete, measurable health and efficiency goals that are related to EHR adoption and meaningful use. These might include reductions in blood pressure among hypertensives, reduced blood sugar levels among diabetics, lower smoking levels, or reductions in health care disparities among populations. The resulting data will provide information for mid-course corrections and will also help independent evaluations judge the success of the program.
In order to make maximum use of existing federal resources, Beacon Communities also will be expected wherever possible to tap into other existing federal programs that are working to promote health information exchange at the community level. Close coordination with the Regional Extension Center Program, State Health Information Exchange Program, and the national Health Information Technology Research Center (HITRC), will ensure that lessons learned are shared for the benefit of all. Beacon Communities are expected to maximize their efforts by leveraging other existing federal programs and resources that are working to promote health information exchange at the community level, including the Department of Defense and the Department of Veterans Affairs development of a Virtual Lifetime Electronic Health Record (VLER) for all active duty, Guard and Reserve, retired military personnel, and eligible separated Veterans.
I’ve spoken often of my own experience with electronic health records in medical practice, and my resulting conviction that access to electronic health information at the point of care made me a better doctor, and helped my patients. I’ve highlighted examples of health systems, large and small, urban and rural, that have experienced major improvements in care and reduced costs resulting from the use of EHR systems and health IT. And I’ve shared the opinions of experts who conclude that the entry of the medical profession into the digital age is much needed, and long overdue. The Beacon Community Program will enable us to test the capacity of health IT to accomplish this shared vision at an accelerated pace. We hope these communities will truly prove beacons that the rest of our health system can use to guide our collective efforts to use information to improve the health and health care of Americans.
Sincerely,
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services
The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.
HHS releases $80 million to train HIT workforce November 30, 2009
Posted by gonzalezloumiet in Uncategorized.Tags: Education, HHS, HITECH
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November 24, 2009 | Diana Manos, Senior Editor
WASHINGTON – The Department of Health and Human Services will release $80 million in grants to help develop and strengthen the health information technology workforce.
The grants consist of $70 million for community college training programs and $10 million to develop educational materials to support the programs, said David Blumenthal, MD, the national coordinator for health information technology, during a Tuesday morning press call.
Both programs will support the immediate need for skilled HIT professionals who will enable the broad adoption and use of healthcare IT throughout the United States, he said. The funding is authorized by the American Recovery and Reinvestment Act and is the first that will fund a series of programs to help strengthen and support the healthcare IT workforce.
Additional details regarding the grant programs will be announced over the next several weeks, Blumenthal said.
"Ensuring the adoption of electronic health records (EHRs), information exchange among healthcare providers and public health authorities and redesign of workflows within healthcare settings all depend on having a qualified pool of workers," he said. "The expansion of a highly skilled workforce developed through these programs will help healthcare providers and hospitals implement and maintain EHRs and use them to strengthen delivery of care."
According to Blumenthal, the community college program will establish intensive, non-degree training that can be completed in six months or less by individuals with some background in either healthcare or IT. Participating colleges will coordinate their efforts through five regional consortia.
Graduates will fill a variety of roles that both assist healthcare practices during the critical process of deploying IT systems and support these practices on an ongoing basis.
The curriculum development program will make high-quality educational materials available to the community colleges so these training programs can be established quickly to meet workforce needs, Blumenthal said.
Any U.S. non-profit institution of higher learning currently engaged in providing healthcare IT training that is interested in drafting curriculum or establishing a consortium that includes community colleges may apply for the grants.
"Critical to achieving the goal of the Heath Information Technology for Economic and Clinical Health (HITECH) Act and supporting meaningful use of healthcare IT is the availability of a skilled workforce that understands the unique technology and management needs within a clinical setting," Blumenthal said. "These newly funded programs are designed to equip the most qualified and advanced IT workforce in the world with the tools they need to modernize our health system."
Source: http://www.healthcareitnews.com/news/hhs-releases-80-million-train-hit-workforce
HHS Launches New Blog: Health IT Buzz November 23, 2009
Posted by gonzalezloumiet in Blumenthal, HHS.Tags: Blumenthal, HHS, HIT
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FOR IMMEDIATE RELEASE
Monday, November 23, 2009
Contact: HHS Press Office
(202) 690-6343
HHS Launches New Blog: Health IT Buzz
Dr. David Blumenthal, HHS’ National Coordinator for Health Information Technology, today announced the launch of Health IT Buzz, a new blog that will allow readers to learn more about health information technology (health IT) and provide a space for consumers, providers, policymakers, and technology experts to share their ideas and concerns regarding health IT. The blog is available at http://healthit.hhs.gov/blog/onc.
Dr. Blumenthal will hold a conference call with members of the media on Tuesday, November 24, to discuss the blog and the availability of new grants to strengthen the health IT workforce.
The American Recovery and Reinvestment Act included historic new resources to improve health care through advances in health IT and provided incentives to hospitals and providers who meaningfully use health information technology. Health IT has the potential to improve the quality of care for patients and make care more efficient.
The Office of the National Coordinator for Health Information Technology’s activities that will be discussed on Health IT Buzz include:
- Activities to advance standards to achieve interoperability, which will ensure accurate and widespread exchange of health information;
- Evaluation of new options for the certification of electronic health records;
- Exploration of health IT related regulatory and guidance initiatives to protect the privacy and security of health information; and,
- An assessment of critical privacy and security issues.
Information regarding the conference call on Tuesday is included below.
WHEN: November 24, 2009
9:30 a.m. EST
DIAL-IN: 888-390-0868
Passcode: ONC
Note: This call is for members of the media only.
Computerized medicine: good for quality, but not costs November 22, 2009
Posted by gonzalezloumiet in Health IT.Tags: EMR, Health IT, Obama
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A longitudinal study of thousands of US hospitals suggests that increasing the levels of medical IT may modestly improve the quality of treatment, but it doesn’t actually help with costs, and may even make things worse in the short run as the current US healthcare economy is subverting any benefits it might otherwise provide.
By John Timmer | Last updated November 20, 2009 2:20 PM
Electronic medical records and the general digitization of medical data and practices are promoted as a way to slow the rapidly inflating costs in the US healthcare system. The push for expanded medical IT has come from the top, with President Obama extolling its virtues and his administration making funding for EMR deployments part of its stimulus package. But many have pointed out that simply throwing computers at a problem isn’t a solution unless the software and practices are also in place to allow the medical community to leverage the technology efficiently. A study of US hospital data suggests they may not be: computerization only had a mild impact on quality of care, and it didn’t seem to alter costs in any significant manner.
The study will appear online at The American Journal of Medicine Friday. Its authors combined three datasets that collectively track the computerization and outcomes at thousands of US hospitals. Data on the deployment of medical IT systems were obtained from an annual survey performed by the Healthcare Information and Management Systems Society. The survey contains over 20 measures of computerization, including both administrative and clinical functions.
Costs and quality of care were obtained from Medicare and Medicaid data, both obtained directly from the government and from a version compiled by the Dartmouth Health Atlas. The latter contains information such as whether the hospital is for-profit, the type of care delivered (acute, psychiatric, etc.), and its location. Quality of care scores were available for pneumonia, congestive heart failure, and acute myocardial infarction. The authors looked at the period from 2003 to 2007, during which time information was available for roughly 4,000 US hospitals.
During the time in question, there was a large increase in the use of computerized systems. By 2007, a typical hospital had implemented nearly two-thirds of the computerized systems covered in the survey, although there was a bias towards adoption of administrative systems. Less than a quarter of the hospitals, for example, had implemented a computerized ordering system for their physicians.
Despite the rise in computerization, however, administrative costs actually climbed slightly during the entire period. Part of this seems to be the costs of deploying the systems themselves, as hospitals in the midst of a major IT expansion had increased administrative costs during this period. Checking the data using a four-year interval, however, suggested that even once the systems are in place and in use, costs don’t start to decline. Still, none of the statistical tests performed by the authors showed a clear correlation between computerization and administrative costs.
The authors performed bivariate analysis to try to identify the factors most closely associated with costs and quality of care. Hospitals that did best on quality of care tended to be larger, nonprofit, and associated with teaching programs. Computerization tended to increase the quality of care for acute myocardial infarction, but not either of the other problems. Multivariate analysis suggested that the improvement may be correlated with the use of computerized systems that focus specifically on patient care.
"We found no evidence that computerization has lowered costs or streamlined administration," the authors concluded. "More encouragingly, greater use of information technology was associated with a consistent though small increase in quality scores." That’s not exactly a ringing endorsement of healthcare IT, and it’s certainly a far cry from some of the improvements promised by its proponents.
Why the disparity? The authors provide three potential explanations. One is simply that the cost of purchasing and supporting IT equipment and software offsets any savings they produce. The other is that the four-year lag used in their analysis to look for long-term savings simply isn’t sufficient; savings will eventually appear, but only once the systems are in use for long enough for everyone to become proficient with them.
They favor the third possibility: the commercial medical marketplace is simply structured in a way that doesn’t favor optimal solutions. "Coding and other reimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical parsimony," they suggest. "The largest computer success story has occurred at Veterans Administration hospitals where global budgets obviate the need for most billing and internal cost accounting, and minimize commercial pressures."
In other words, the current US healthcare economy is subverting any benefits that computerized healthcare might otherwise provide.
The American Journal of Medicine, 2009. DOI: 10.1016/j.amjmed.2009.09.004



