Part three of a three-part series (Access parts one and three):
Health information technology became a central issue this year as the federal government pushed a number of initiatives to increase IT adoption among providers at all levels. In doing so, several key issues were raised, from transparency and interoperability to the privacy of data being exchanged and the cost of implementing that exchange. In all, 2008 might be known as the year of the electronic health record, which is seen by some to be the defining technology that is expected to bring together all facets of the health-delivery system, though many still question its effectiveness and expense.
Over the past year, Health IT Strategist
has chronicled the key issues affecting the industry. Take a look at what readers found to be the most important, based on a review of page views for stories.
EHR penetration rates
Before hospitals and office-based physicians can create computerized health records for their patients, they need to have and use electronic health-record systems in their workplaces.
Sounds simple enough. But the Bush administration's "market" approach to EHR promotion has been met with adoption ennui.
Before 2008, many entities inside government and out attempted to measure EHR adoption, but ran into the problem of each surveyor using a different definition of what features and functions an EHR ought to have, or allowing the survey respondent to self-define whether they had an EHR. (Complicating the problem further, the very name for the systems over the years has varied, including electronic patient record, electronic medical record and, most recently, EHR.)
At least the system definition problem might be resolved for the time being, thanks to a 2005 HHS contract with some researchers at the Harvard School of Public Health, the Institute for Health Policy at Massachusetts General Hospital, Boston, George Washington University and RTI International. They settled on 16 key elements that were required for an office-based EHR to be called "fully functional" and seven to be considered "basic." For hospitals, a "comprehensive" EHR has 24 functions, a basic system, nine.
Trouble is, very few hospital or physician offices have adopted EHRs by either description, but only miniscule percentages of either have implemented and are using top-end devices. For example, according to a survey report
released in November 2008, just 1.7% of hospitals surveyed had fully implemented a comprehensive EHR across all units of their hospitals and only 7.9% had implemented a basic system.
The same group of researchers in June reported
that only 4% of physicians in ambulatory-care facilities have a fully functional EHR available while 13% had an EHR with the basic functionality.
Personal health records
Personal health records became a big topic this year as health information technology advocates began to strongly support the use of the patient's electronic health record within the larger interoperable network of health information exchange.
The issue garnered more attention early in 2008 when IT giants Google and Microsoft Corp. rushed to release
their versions of a PHR for patients to manage their own information online. Since then, standards developers
and other IT certification organizations
have pushed for common measurements and technology standards
to ensure PHRs work seamlessly with other EHRs and health information exchange organizations.
The Center for Information Technology Leadership reported
that using PHRs in interoperable systems to move patient information like laboratory results and medication lists could save payers and providers $21 billion annually. As stakeholders wondered
whether PHRs were replacing the federal initiative of a national EHR, the government said its PHR pilot projects were designed to further consumer-driven healthcare.
Consumers want those records, too, but they remain concerned about the privacy and security of their electronic information, according to a report
by the Markle Foundation, which supports interoperable records. Through its Connecting for Health program the foundation is developing a framework
to ensure interoperable PHRs.
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