Value-Driven Health Care Interoperability

I thought you might be interested in a brief report on our progress related to electronic health records (EHR). They are a critical element in making the health care system become value-based.

Just having electronic health records isn’t enough. The systems have to be interoperable. Interoperability means that different computer systems and devices can exchange information.

Three years ago, there were 200 vendors selling electronic health record systems but there was no assurance that the systems would ever be able to share privacy protected data in interoperable formats. Since then, we have made remarkable progress.

An EHR standards process is now in place, and we are marching steadily towards interoperability. We created the CCHIT process to certify products using the national standards and it is functioning well. More than 75% of the products being sold today carry the certification.

In addition, a National Health Information Network will start testing data exchange by the end of the year and go into production with real data transmission the year after.

The number of hospitals and larger physician practices employing electronic medical records has grown. However, we continue to have a serious challenge with small- to medium-sized practices where fewer than 10 percent of these practices currently have health IT systems.

The primary reasons for low adoption rates among small practices are predictable: economics and the burden of change.

We are experimenting with different methods of changing the macro economics of reimbursement so that small practice doctors share the financial benefits.

We are also beginning a pilot program that provides Medicare beneficiaries with personal health records.

Finally, HHS is signaling that in the near future, payers like Medicare cannot reimburse doctors at the highest level unless they can interact at the highest level of efficiency.

A good example of this is e-prescribing. The software exists in nearly all pharmacies and in many doctors’ offices. It saves money and lives. It’s time to fully implement e-prescribing.

I’m hoping Congress will give HHS the ability to establish e-prescribing requirements as part of Medicare legislation in June of this year.

Learn more about Value-Driven Health Care.

Comments

Mr. Secretary Leavitt,

Though I work in the computer field EHR scares me. The benefits are real. Fast timely information that is harder to loose and easier to track who made what changes and fewer errors. It is a big boost to those who travel. Yes, there is a great reduction in space to store the data and far greater reduction in time to retrieve it.

My fears stem from leaving copies of medical records everywhere like bread crumbs. Like Citi Bank, the last time Disney corp was hacked was at a subcontractor - not their main site. I worry my family or friends stuff would be hacked at a small doctors office.

One thing we teach the scouts is to put emergency phone numbers on USB device in the public and personal info under encrypted folder on the USB. Hence there is some info people can access but other stuff they need your permission for.

The problem is anything that can be read on USB, can be copied.

As always - having this info on a USB might be a great idea during a pandemic, or after tornado, hurricane, flood, tsunami, etc when medical systems are swamped or down. When the kids get their sports or camp forms filled out, photo copy them incase of emergency. I have not met an EMT who was happy to see one.

Regards,
Kobie
"Man becomes cleaver, before he becomes smart or wise" - Kobie

Posted by: Kobie | May 14, 2008 at 03:43 PM

Mr. Secretary: As one of the founders of HL7, I applaud your efforts toward EHR adoption and interoperability. However, I am concerned that the focus on adoption has led to insufficient attention to the downsides of EHRs. Like any other tool, EHRs can be used for destructive as well as constructive purposes. I am particularly concerned that ONC is not responding to recommendations from expert panels it has funded to build in proactive fraud management functions into EHR requirements. Some of those recommendations have been resisted by physicians and vendors, the result being a retreat from this issue by your department owing to a concern that EHR adoption may be slowed. EHR adoption is important, but not at any consequence. We have an estimated $200B/year fraud problem that all experts agree will become greater in an electronic environment without proactive fraud management functions built in from the beginning.

Posted by: Donald W. Simborg, MD | May 15, 2008 at 11:41 AM

The other two comments are dead spot-on. What do you think about this: the company for which I work (a 14000-employee international Fortune-100 firm) decided mid-year (i.e. 6 months after general enrollment) to move the claims information of all employees to an RHIO without seeking separate HIPAA permission. Then they announced they had done this. There will be no information sharing sessions with the employees of the RHIO for yet another month.

When I found out what had happened, I immediately submitted opt-out forms and was told (actual quote) "We have your opt-out form, and we will have your data removed in 2 to 4 weeks." No kidding. Then I threatened a HIPAA complain and they suddenly and magically manged to remove my data in less that 24 hours.

But here's the kicker: although I am opted-out at this time, I'm told by my company, the RHIO and even by a DHHS-OCR employee that there is no guarantee that a) my data won't inadvertently wind up out there again, b) I will stay opted-out and won't have to opt-out annually at general enrollment time and c) sometime in the future, my company may make it a condition of providing insurance coverage that my and my dependents' private personal health information be made accessible on the Internet.

I personally have no problem if people are given information and make informed decisions not under duress to opt-in to allowing their information to be available on the Internet, but I would never do that. And I guess if my choice is to allow that or not have medical coverage, I would allow it.

I still do not understand what is the advantage to me and my dependents', who see a total of about 6 health care professionals a few times a year and consume a total of 2 prescribed medications, to having our data out there on the Internet. Maybe you could help me with that, because my employer and the RHIO has utterly failed to make their case.

Thanks for allowing me to vent.

Posted by: Erich Noll | May 16, 2008 at 01:04 PM

Guess what, I attend the University of Utah, and we have a college readership newspaper program on campus. I especially like the New York Times, so this morning I picked up a copy of it to read before my English class started.

I saw an ad that said "Compare the Quality of Your Local Hospitals"! It was a full page add with bars comparing a bunch of hospitals, and a quote from Daisy about it being better to have more information. It was on page A11.

I immediately thought of you and your blog. Thanks for keeping us updated on what you're doing.

Posted by: Emily | May 21, 2008 at 02:42 PM

As a office manager in a solo practice, the idea that it is time to fully implement E-prescribing is off-base. For our practice, the cost would be $500 per year with no return on investment for our practice. Why would we ever purchase this with zero ROI? The benefits accrue to the government, insurance companies and other parties, not the physicians themselves.

Reducing the profitability of the solo practitioner is the antithesis of a pro-business policy and should be avoided until a positive business case is made to adopt the technology.

Posted by: Eric Beeman | June 01, 2008 at 11:30 PM

I agree with @Eric Beeman. There's a need to balance the need for full implementation of EHR and E-prescribing with the continued profitability of small practices nationwide. However, I think it's backward-looking to delay implementation because of this and the sentiment of some people that "we live most of our lives here" or "we don't travel," etc. The main issue that should be addressed once you focus on netwide data availability and inter-operability is security, as @Kobie pointed out.

Posted by: Recycling Mike | June 08, 2008 at 11:11 PM

I have a daughter, who works full time, but does not have health insurance, because it is not offered at her place of employment. She also has chronic mental health issues. Two weeks ago, she was given a new medicine that was $20.00/pill. That's $600.00/mo. for one pill. She needs about 8 pills a day to function. I figure her medical bill is about $50.00 day for sanity. I agree the cost of her meds are cheaper than $200.00+ day in a medical center.

Then, I did a little research, and found out I can get her drugs for $1.00-$2.50/each for a day through a canadian e-prescription. Why the difference? Why do US citizens pay 2-10X times for meds? If our drugs are world drugs, why do we bear the burden of all the development, marketing, administrative and profit of drugs? I have friends who are under the impression that all drug companies now offer drug discounts! Wrong! Most drug companies refer working poor to Medicaid, or state programs, so they can get their drugs paid for at a higher market rate. The drug companies have Washington fogged, and they get away with it.

Posted by: cjf | August 19, 2008 at 08:19 PM