Development of standards for electronic interchange of health information will affect every physician practice in the nation. Critics wonder whether efforts to force compliance with these standards is an attempt to move all medical information from paper to computers. However, the National Committee on Vital and Health Statistics of HHS and some healthcare industry groups are focusing attention on the electronic exchange of information as a means to enhance healthcare quality, improve productivity and manage costs.
The Institute of Medicine report "Crossing the Quality Chasm" questions the use of paper records and why many healthcare settings lack the basic computer systems to provide clinical information and support clinical decisionmaking.
The committee endorses creation of a health-information infrastructure to lead to the elimination of most handwritten clinical data by the end of the decade.
Much of the attention to computerized health information now, however, is on administrative simplification requirements of the Health Information Portability and Accountability Act of 1996 that deal with electronic-data interchange (EDI) and privacy and security provisions for health information.
HIPAA is "being purported as an incentive" for physicians who have not yet computerized their records and accounts to do so, says Dennis Myers, M.D., director of medical informatics at Scott & White Hospital in Temple, Texas.
The administrative simplification requirements will begin to go into effect in October 2002. The privacy regulations became effective April 14, giving the covered entities 24 months to comply. Security regulations have not yet been released.
Electronic interchange of information requires standards and protocols that facilitate this exchange and allow interoperability of varying computer platforms and software. Standards initiatives have attempted to develop common medical nomenclatures and forms for reporting medical information and obtaining payment for medical services.
A number of factors besides HIPAA also have focused attention on the development of standards for electronic exchange of information. They include growth of the use of the Internet for healthcare administration and services and efforts to address medical-error rates after the release of the first IOM report in 1999.
Another factor is the proposed development of the National Health Information Infrastructure. The NCVHS defines the NHII framework as "a set of technologies, standards, applications, systems, values and laws that support all facets of individual health, healthcare and public health. The broad goal of the NHII is to deliver information to individuals-consumers, patients, and professionals--when and where they need it, so they can use this information to make informed decisions about health and healthcare."
But an information lag apparently already may exist in regard to standards development and implementation.
Ed Larsen, who produces the Standards Highlights newsletter for the Ann Arbor, Mich.-based Center for Healthcare Information Management, an association of healthcare vendors, estimates that only 3% to 4% of healthcare providers may be aware of the pending changes, even with the attention surrounding the HIPAA regulations.
"The provider community is the farthest behind the curve now," says James Schuping, the executive director for the Reston, Va.-based Workgroup for Electronic Data Interchange, an advocacy group that promotes electronic exchange of health information.
"A lot of smaller providers are still not at even the awareness stage," says James Scanlon, executive staff director for the NCVHS.
Schuping contends the goal of HIPAA and related standards initiatives is to improve medical care.
With electronic interchange of health information, "we will be able to administer medical care in a much more cost-efficient manner," he says, and these efficiencies will give providers more time for the actual delivery of health services.
But some question the cost of such increased efficiency, even if it comes. "HIPAA will make Y2K look like a romp in the park," Myers says.
Myers says he has not seen adequate justification for any purported cost savings because of increased efficiencies from HIPAA.
In August, HHS projected that by promoting greater use of electronic transactions and elimination of inefficient paper forms, the HIPAA EDI regulations would provide a net savings to the healthcare industry of $29.9 billion over 10 years.
Compliance costs for the privacy and security regulations, however, may total billions of dollars for the healthcare industry, Myers says. "Medical dollars are medical dollars."
Among the beneficiaries of the spending for HIPAA compliance will be vendors and consulting firms. "It will be a growth industry," Scanlon says.
Schuping acknowledges that WEDI, whose membership includes provider organizations, vendors and government agencies, had lobbied for such regulations.
An issue for some, however, is the difference between the notion of "standards" and the regulations that HIPAA provides. "Standards are voluntary," says Larsen. "HIPAA is mandatory."
Meeting the EDI provisions is rather basic, but Larsen says the privacy and security regulations are different and require providers "to give them information on quality of services."
Scanlon acknowledges that HIPAA is an attempt "to put some teeth into the standards. With the regulations, it really has the force of law. We need the force of the law."
Although HIPAA has received much of the attention in the promotion of standards initiatives, Carla Smith, executive director of CHIM, says the top priority for her group is medical errors.
The key, Smith says, is "to have access to good information at the point of care."
Needed to reduce medical errors, she says, are a standard medical nomenclature and an information system designed to learn from medical errors on a large scale.
CHIM is in the process of surveying its members to obtain data for such a system, she says.
But Myers says the medical errors issue may be just a ploy. Groups are using medical errors as an excuse "to get people to do what they want them to do anyway," he says, which is to computerize all healthcare information.
While Ed Hammond, professor of community and family medicine at the Duke University Medical Center, says "there's no question" that addressing medical errors requires an adequate set of interventions and good information, the standards development for health information preceded the 1999 report that focused public and government attention on medical errors. Standards development has been under way for years, Hammond says.
The HIPAA requirements just have "focused attention on these efforts," he says.