The head of the nation's largest hospital accreditation body is challenging the federal government to take the lead and provide funding for development of a national healthcare information infrastructure.
"For the federal government not to be involved would be a poignant statement of public policy by itself," says Dennis O'Leary, M.D., president of the Joint Commission on Accreditation of Healthcare Organizations.
In addressing the question of whether the private sector alone can overcome existing barriers to automating medical records, O'Leary says, "The experience today suggests that the answer is clearly no."
However, O'Leary stops short of calling for a law or regulation that would require health providers to move to electronic medical records, at least before federal officials encourage EMR installation by adopting existing privately developed standards for federal health programs like Medicare and the Military Health System.
"However, to issue a mandate before these other steps are taken would be a classic case of 'Ready, fire, aim'--at best, a bullet is wasted, at worst, it creates an unintended victim," O'Leary says.
He also suggests the federal government could fund private-sector standards development projects.
O'Leary made his comments Tuesday in San Diego at a mock congressional hearing staged at the annual Healthcare Information and Management Systems Society conference.
Russell Ricci, M.D., global healthcare general manager for IBM Corp., told the panel that any IT initiatives coming out of Washington should encourage or force fundamental changes in the healthcare payment system.
"Healthcare's misaligned reimbursement system does not reward quality," Ricci says. "For example, in Medicare we pay based on volume, procedure, geography and labor costs, but not success in treating a patient."
Other witnesses who appeared before a panel of health informaticists and former congressional staffers were split on the role of government in the creation of a national healthcare IT infrastructure.
Michael Minnear, senior vice president and CIO of the University of Maryland Medical System in Baltimore, says the federal government should mandate EMRs within the next five to 10 years.
"It is the only entity that can focus the attention and resources to bring modern information technology to the healthcare industry," he says.
Such a move, Minnear adds, would aid in public health crises and disaster response.
Jeff Blair, vice president of the Newton, Mass.-based Medical Records Institute, says Washington should adopt standards, provide incentives and perhaps help fund EMR implementation, but he suggests that a mandate may have unintended consequences.
Noting that it has taken nearly seven years since the passage of HIPAA legislation in 1996 for the first of the administrative simplification regulations to take full effect, Blair says similar efforts to govern EMRs may have the effect of "constraining the nation" on attempts at innovation.