Healthcare IT: An Update

More than 30 standards organizations, advocacy groups, and government agencies convened in early June for the first National Health Information Technology (IT) Week. The event was designed to share development and implementation experiences to date, promote a common agenda, and advance the goal of achieving a safe and secure national system of electronic health records (EHRs) by 2014. Recognizing the plethora of groups now promoting healthcare IT initiatives, the theme of the week's agenda was “one vision, one voice.”

National Health IT Week participants also urged quick congressional approval of the healthcare IT legislation that is currently bogged down in the House.

Although many thought the Health Information Technology Promotion Act of 2006 (H.R. 4157) would be approved before the Independence Day break, representatives have yet to resolve the differences in two competing bills—one from the House Ways and Means Committee, the other from the House Energy and Commerce Committee. Both bills codify the Office of the National Coordinator for Health Information Technology, which was originally enacted through an executive order in April 2004. However, the bills include different privacy provisions and timetables for moving from the ICD-9 to the ICD-10 medical coding systems.

Although spokespersons for both committees are promising a resolution soon, the bill would still require approval by the rules committee, a vote by the full House, and reconciliation with the already-approved Senate version—a process that is expected to take several months.

Also urging passage of the House bill during National Health IT Week was Newt Gingrich, former House speaker and now head of the Center for Health Transformation (Washington, DC). He compared the need for a national healthcare IT system to President Eisenhower's signing of the Federal-Aid Highway Act of 1956. “Fifty years later, another national, interconnected system is needed,” he said. “Our generation must build a national health information system because it, too, is vital to our national security.”

Gingrich noted that more than 1 million paper-based medical records were destroyed by Hurricane Katrina's floods. “Nearly all citizens fled the Gulf with no medical histories, no medication lists, no treatment regimen, no lab results—no healthcare documentation of any kind.”

Electronic health records achieved another milestone in implementation this month when the Certification Commission for Healthcare Information Technology (CCHIT; Chicago) approved the first ambulatory care programs that meet the functionality and security criteria set forth in its standard. Products achieving certification will bear the CCHIT-certified seal. Ambulatory care EHR systems from 17 vendors were approved, and CCHIT plans to certify the first EHRs intended for in-patient hospital applications in 2007.

While some vendors complain that the $28,000 certification fee is too costly and could drive small companies out of the business, CCHIT notes that the certification program is voluntary. Mark Leavitt, CCHIT chair, said, “This seal of approval removes a significant barrier to widespread adoption of electronic health records. It gives healthcare providers peace of mind to know they are purchasing a product that is functional, interoperable, and will bring higher-quality, safe care to patients.”

The Electronic Health Record Vendors Association (EHRVA), an organizational unit of the Healthcare Information and Management Systems Society (HIMSS; Chicago), hailed the certification of the first ambulatory EHR programs. Charlene Underwood, EHRVA chair and director of government and industry relations for Siemens Medical Solutions (Malvern, PA), said, “We support independent, private-sector product certification as one mechanism that improves adoption by making it easier for providers to compare and purchase both certified and noncertified products.” But Underwood also noted that many EHR vendors believe the healthcare industry needs to provide incentives for the use of such systems and finalize crucial interoperability standards in order to accelerate acceptance and adoption of EHR solutions.

Spending on EHR implementation continues to grow, but according to the Rand Corp. (Santa Monica, CA), the rate of adoption is currently just 15–20% for physicians' offices and 20–25% for hospitals. According to Health Industry Insights, a research unit of IDC (Framingham, MA), the U.S. EHR market is expected to post a compound annual growth rate of 15.8% over the next 10 years—increasing from $1.1 billion in 2005 to $4.8 billion in 2015.

Implementation costs for EHRs remain high. According to the Rand report, it will cost $98 billion and take 15 years for 90% of the nation's hospitals to adopt EHR systems. The cost for physicians' offices would be $17.2 billion.

In addition to costs, the adoption of healthcare IT, healthcare enterprise networks, and related systems represents a disruptive technology—a profound change in the way clinical information is structured and delivered. Although resistance to computerization is no longer an issue with today's tech-savvy healthcare professionals, significant concerns remain about IT support, patient management, and the certainty of universal standards in the e-health era.

Although there is now a bevy of standards organizations and an industry commitment to open architecture, many hospitals and doctors' offices seem reluctant to invest in clinical IT systems before the connectivity standards are firmly in place and interoperable EHRs, medical devices, and networking products and equipment are readily available.

Speaking before a Senate panel on interoperability, Terry Ragon, founder and CEO of database company InterSystems (Cambridge, MA), said, “The lack of interoperability standards inhibits sharing of medical data between facilities, and it also inhibits health surveillance and other public health projects.”

Yet, Ragon also said that the main barrier to further adoption of healthcare IT by hospitals, clinics, and physicians “is not standardization and certification—it's money.”

The pace of healthcare IT adoption has not picked up the momentum for which many had hoped, and it is now widely believed that a national EHR system will not be achieved by the initially stated goal of 2014. Additionally, the role that the medical device industry will play in this process is still largely undefined. Apart from the recently announced formation of the Continua Health Alliance (see related story in this issue of MX: Issues Update), medical device manufacturers have been, for the most part, conspicuously absent from healthcare IT and related EHR initiatives.

© 2006 Canon Communications LLC

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