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Center for Health Transformation

Accelerating universal adoption of health IT is fundamental to creating a safer and more affordablehealth system.

What Are the Goals And Objectives of EHRs?

The Center for Health Transformation advocates the creation of a 21st-century intelligent health system. Our vision is of a health and healthcare system that is centered on the individual, not the provider or hospital. Prevention and wellness are fundamental priorities. Care is driven by outcomes, not by volume. Consumers own their data and have a right to know cost and quality information. Innovation is rapid. The dissemination of knowledge is in real time. All of this must be built upon an electronic system. It cannot happen with paper.

Paper kills — it’s that simple. Instead of saving lives, our current system is taking them.With as many as 98,000 Americans still being killed by medical errors every year, ridding the system of paper-based records and quickly adopting electronic health records (EHRs) will save lives and, at the same time, save money.

This is not just a theory. Health information technology (HIT) is vital to making American healthcare the safest it can possibly be. Already we can witness the benefits. Indiana Heart Hospital in Indianapolis built a new facility that is totally paperless. They reduced medication errors by 85 percent. If we could get the same results nationwide, we’d save at least 7,500 Americans, since medication errors kill nearly 9,000 citizens every year. Indiana Heart also reduced physician administrative time by 30 percent. This means that doctors can now spend more time with their patients and provide them with higher-quality care.

There are plenty of programs working today that may serve as examples of how a technology-enabled health system can save lives and save money. For instance:

• Danville Regional Medical Center in Danville, Va., utilized Siemens Medical Systems’ electronic prescribing system and prevented more than 1,200 wrong drugs or dosages, saving countless deaths and untold suffering, as well as nearly $750,000.
• Central Utah Multi-Specialty Clinic, the largest independent multi-specialty group in the state of Utah, with 59 physicians and nine locations, implemented an electronic medical record built by Allscripts Healthcare Solutions. The clinic saved $1 million in the first year through direct spending reductions and revenue increases. They anticipate saving more than $14 million over the next five years.
• PeaceHealth is a six-hospital system in Alaska,Washington and Oregon.Working with IDX, they created the community health record, an electronic record for every one of their 1.4 million patients. The community health record is totally online, HIPAA-compliant and can be accessed by all the stakeholders: hospital doctors and nurses, independent physicians, specialists, health plans and patients. The results are phenomenal: adverse drug events cut by 83 percent; for diabetics, A1C levels less than seven jumped from 44 percent in 2001 to more than 60 percent in 2004; for patients with cardiovascular disease, LDL levels of less than 100 jumped from 28 percent in 2001 to 52 percent last year. Their patients are healthier and their quality of life is dramatically better.

The urgency of adopting HIT cannot be overstated.We must build a 21st-century intelligent health system that brings healthcare into the information age. HIT is one of the vital levers to accomplish this worthy goal.

What Are the Roles of Various Constituent Groups?

Everyone in health and healthcare must make modernizing the system the top priority. Hospitals, providers and insurers cannot wait for interoperability standards to coalesce before investing in HIT.We will lose far too much time if they do that. The private sector must aggressively move on HIT because it is a matter of life and death. The Centers for Disease Control and Prevention recently reported that only 31 percent of hospital emergency rooms, 29 percent of outpatient departments and 17 percent of doctors’ offices have EHRs to support patient care. That is shamefully low. Facilities like PeaceHealth, Danville Regional and the Central Utah Clinic did not wait for the rest of the industry to make up its mind. They implemented cutting-edge technology and saved lives and saved money. Everyone should use this approach.

Patients must also get engaged. A majority of Americans do not take responsibility for their own health or healthcare seriously, and the debate over interoperability and electronic health records is meaningless to most. If individuals began seeking out providers who used electronic records, the adoption rate would no doubt begin to accelerate, driven by consumer demand. Americans are key to changing the healthcare marketplace, but to do so they must become informed advocates for their own health and well-being.

One thing every individual can do is sign up for an iHealthRecord, a new online personal health record available to anyone. The service is free to individuals but does charge a monthly fee to physicians. Approximately 100,000 doctors have signed up to use it, and it has been endorsed by the American Medical Association, the American Heart Association and dozens of medical societies and other groups. Individuals can use an iHealthRecord to send a secure email to their doctor, research medical conditions, treatments and healthy lifestyles and store vital health information. In addition to using an iHealthRecord for regular care, an ER doctor can use this information in an emergency away from home. It could save someone’s life. Getting individuals and doctors accustomed to using an online health record is imperative to building a 21st-century intelligent health system.

The private sector must take decisive action to realize the full potential of HIT, but government will play a critical role as well. Congress and the Bush administration should make funding HIT a top priority — on par with national security. Millions of lives are at stake. Dr. David Brailer, President Bush’s national coordinator for health information technology, has said that HIT could save the healthcare system upward of $140 billion a year. These savings could be used to expand coverage to the nearly 45 million Americans who have no health insurance. The savings could also be used to find solutions to the diabetes and obesity epidemics that are overwhelming our nation. Despite projected budget deficits for years to come, the federal government should dedicate 1 percent of all federal spending to HIT. Seven billion dollars a year is a lot of money, but the return on this investment cannot be overstated. We would save hundreds of thousands of lives and hundreds of billions of dollars.

One solid step in the right direction is all of the momentum on Capitol Hill and in the Administration. Secretary Leavitt has been out in front of this issue since day one, and his leadership will make a difference. There are also at least seven different proposals on HIT pending in the House and Senate. From Congressmen Tim Murphy, a Pennsylvania Republican, and Patrick Kennedy, a Rhode Island Democrat, to Senators Bill Frist and Hillary Clinton, these bipartisan bills will play an integral role in modernizing healthcare and moving our system into the information age. Most of the proposals provide financial incentives for doctors to invest in HIT, and allow local hospitals to supply the doctors in their community with the infrastructure needed to electronically exchange patient information. It is another indication of how backward our current health system is that this practice is presently forbidden by law.

These bills also encourage private-sector innovation through federal grants to regional groups that are trying to electronically connect patients, doctors, hospitals and insurers. In addition, these bills will promote accelerated transformation by requiring that those regional organizations adopt common technology standards, meaning that variant systems from diverse locations must be able to communicate with each other.

Beyond these bills’ commitment to health transformation, it is imperative that the federal government take decisive action to promote widespread HIT adoption. Changes to the administration of public health programs could accelerate adoption — the Medicare and Medicaid programs, for instance, could make HIT an essential component of healthcare delivery by creating financial incentives for providers who use it. In addition, federal agencies should coordinate on federal HIT strategy and on the interoperability of their own implementation, rather than continuing to operate in silos.

How Does Your Approach Differ From Other Proposed Solutions?

First, we believe that what is needed is transformation, not reform. Rather than focusing on small changes or reactionary fixes to pieces of the system as many groups do, we focus on transformation of the entire system. It’s like the difference between passing legislation requiring doctors to write legibly and passing legislation requiring doctors to use e-prescribing. One is a small (not to mention unlikely) change to the current system and the other creates a whole new system.We focus on — and have the reputation of being as good as about anyone at — discovering, creating and impacting key leverage points that will accelerate the transformation of the entire system.

Second, we believe that you have to involve a broad coalition of stakeholders. Our members represent a very wide spectrum of stakeholder groups, many of whom are not accustomed to working together.We bring together provider groups, hospitals, health plans, employers, technology vendors and patient and issue advocates, as well as government leaders at the state and the federal levels. It makes a huge difference to have both the perspective and the influence of leaders across the board when trying to accomplish the level of change we’re advocating.

Third, related to the second point, we are a collaboration of leaders. Both words are important.We think the only way it’s possible to transform the system is by building a critical mass of leaders who collaborate to get it done. One person or one stakeholder group — or one political group for that matter — can’t do it alone.

Fourth, we are vision-driven. We have a clear vision of a 21stcentury intelligent health system in which knowledge saves lives and saves money for every American. While our members may not agree with every one of our strategies and while some may be competitors in the marketplace, they come together at the Center because they share a larger vision of a better future. That vision and our vision principles create a common ground, bringing us together and helping drive and guide our activities.

Fifth, we are focused on solutions, not problems.We are constantly learning, constantly searching and constantly creating new solutions and new policies, which we then work to drive through the system as rapidly as possible. One of our key rules with regard to being solution-oriented is to always say “yes, if …” not “no, because … ” It’s amazing how much that one habit can do to help a group work together to create solutions rather than bickering about problems.

What Are Some of the Implementation Challenges?

One challenge is reaching an agreement on interoperability standards for EHRs. Many companies develop EHRs, and they are built on technology platforms that differ from one system to the next. If these products cannot talk with one another, the goal of building an interconnected system will never be realized. The EHR Vendors Association, physician groups, standards-developing organizations and others should converge upon one standard. Duplicative standards would be inefficient and delay adoption indefinitely. Every day that we waste bickering over proprietary interests and which standard to use we kill countless Americans. The industry and lawmakers must reach agreement on a single standard and move forward.

Stark and anti-kickback statutes are also barriers to rapid HIT adoption because they prevent hospital systems from providing HIT to physician offices and clinics. Laws such as these are part of a larger question: Who is going to pay for the investment in health IT? Until Congress makes HIT funding the top priority it should be, the private sector must make the investment.

One solution is for large hospital systems and other entities to provide the IT infrastructure to surrounding physician practices and clinics.While many hospitals, medical groups and other organizations would be willing to do this, current Stark and antikickback laws stand in the way. The Government Accountability Office (GAO) concluded as much in a recent study. These laws were meant to protect patients from fraudulent and corrupt referring arrangements. But by preventing the rapid adoption of HIT, they are not protecting patients — they are endangering them. Congress should create new HIT exemptions giving hospitals the ability to fund HIT for community doctors, but they should come with an important requirement: The technologies provided must be interoperable once data standards are announced by the Secretary of HHS. Such a requirement would allow doctors to use the technology to refer their patients to any hospital, not just the one that supplied the technology. This would embrace the spirit of the laws while allowing the private sector to move ahead.

Finally, to address one major challenge, Congress must reform the way legislation is “scored.” Currently, the Congressional Budget Office and the Office of Management and Budget view HIT as a cost, not as an investment. They miss the point that after an initial investment, HIT will ultimately save a significant amount of money. The Center for Information Technology Leadership estimates $78 billion in annual savings from sharing electronic patient data. The GAO noted recently the “proven benefits to implementing health IT.” An earlier GAO report cited dozens of examples where HIT brought significant savings. For example, the Mayo Clinic invested in a total overhaul in its clinical information systems and now saves more than $21 million every year. Why do CBO and OMB refuse to score such savings? The fact that investing in HIT will often pay for itself through avoiding duplicate tests, automating chart pulls and review, and eliminating unnecessary hospital admissions and office visits is lost on them. This approach is so short-sighted that it inhibits any serious discussion of meaningful legislation.

What Is on the Horizon for Electronic Health Records? Will There Be Widespread Adoption in the Next Five Years?

EHRs are one piece of an even more powerful system.We call this a “personal health knowledge system.” This system is not an isolated passive record in the 20th century sense, but it is instead a dynamic, interactive and real-time exchange of knowledge.

Through this online system, individuals, providers, insurers and others will exchange four types of information. First, they will exchange clinical information, such as home diagnostic reports, treatment updates, diagnoses, lab results and other details. Individuals will have home health kits that will measure blood pressure, cholesterol, heart rate, glucose levels and other key indicators. The results will be automatically uploaded into the personal health knowledge system where providers will be able to review and monitor the information.When depersonalized, this information would provide an enormous amount of data to mine for emerging trends in treatment and patient care.

Second, a personal health knowledge system will be used to share general information on health and healthcare. Through their system portal, individuals will access websites like MedLinePlus from the National Library of Medicine when they have questions about their health. Individuals will be able to research healthy lifestyles, best practices, treatment options, quality measures, provider performance and other information. Based on the latest research, providers and insurers will send information through the system tailored to an individual’s particular illness, treatment or condition. This is an essentially an “information prescription.”

Third, a personal health knowledge system will be used to exchange administrative information, such as appointment reminders, prescription refill requests, scheduling, address changes and new insurance coverage.

Finally, a personal health knowledge system will be used to exchange information on benefit coverage and insurance information. Based on an individual’s specific insurance coverage, providers and insurers could offer options in care, such as brand name versus generic pharmaceuticals.

A powerful, sophisticated system like this will dramatically improve health and healthcare in America. Giving the research world a wealth of non-identifiable data to mine for best practices that will improve their health and receiving tailored information from their doctor and other sources puts individuals firmly in charge of their health and healthcare. Attaining such a system should be the long-term goal for current EHR vendors and their technologies. It is possible, and we can and must build it.