As federal government leaders get ready to say their piece this week on advancing health information technology, a private-public coalition has set the stage with the beginnings of an industry consensus around technical and financial starting points upon which to build a national movement.
The coalition, called Connecting for Health, issued a preliminary "road map" last week that calls for a common framework for a non-proprietary "network of networks" linking computer systems within a community and eventually across the country. And it recommends a specific method to achieve a decentralized but interconnected computer "highway."
The 70-page summary report also tosses out for debate the first consensus-backed set of financial-incentive levels considered sufficient to get primary-care physicians to join the movement toward electronic medical records. The proposal would cost a funding source, whether the federal government or other contributors, an estimated $7 billion per year for three years.
To build awareness of the need for health IT beyond the healthcare industry, the coalition's representatives from across the broad spectrum of healthcare settled on a consistent set of messages to be used by leaders to promote benefits of health information through connected computers.
The Connecting for Health initiative, in the works since January, timed its first report to coincide with a three-day conference in Washington on building a national healthcare information infrastructure, said Janet Marchibroda, the coalition's executive director. "We hope the recommendations will be incorporated into the government's strategic plan," she said.
The July 21-23 assembly features a much-anticipated strategic policy address by David Brailer, HHS' coordinator of IT initiatives, and appearances by HHS Secretary Tommy Thompson and Senate Majority Leader Bill Frist (R-Tenn.).
Last week's coalition report may give the healthcare industry a sneak peak at some of the points likely to be made in that address. Before Brailer took the coordinator position in early May, he was one of the work-group leaders in the initiative and was "very involved in this project," said Carol Diamond, chairwoman of Connecting for Health.
Since becoming national IT coordinator, Brailer has sounded two themes: Financial incentives should facilitate action but not substitute for private commitment and the biggest unmet need is at the physician-practice level.
The coalition's report concluded that adoption of a basic IT foundation initially amounts to a net cost for physician practices even though computerization ultimately results in a significant net gain in productivity and enhanced patient care.
Getting physicians past the initial financial obstacle and forging a critical mass of participation within communities would require an incentive sufficient to cover the startup and three-year maintenance costs of an electronic record and associated computer hardware with "modest interoperability among providers," the report said.
Based on a typical primary-care physician with 4,000 visits per year or a 2,000-patient panel over a three-year period, the report proposes financial incentives of $3 to $6 per patient visit or 50 cents to $1 per member per month as "a sufficient starting point to encourage and sustain widespread adoption" of an electronic record.
The coalition also threw its support behind an Internet-based method of information interchange that allows all provider organizations to control their own data while making specific details available for viewing by authorized clinicians within and outside their organization.
The decentralized approach nixes a central database to store information from many different sources and instead "leaves clinical data in the control of those providers with a direct relationship with the patient," the report said. The approach also would serve an incremental expansion of national IT capabilities, allowing providers to improve internal IT functions at their own pace and then be able to share data across the street or across the country using common interchange standards.
Ultimately the plan would pave the way for a "federated" approach to a national IT communication system: A linked network of community-level information exchanges able to aggregate clinical data on individuals without the need for a national patient identification number-an issue long abandoned as politically untenable.
Connecting for Health will issue a more detailed final report with recommendations for action by September, Diamond said. "We tried to define a path forward that people can agree to," she said, emphasizing that the notable achievement for now was that "We got a broad group to agree on a shared path."
The initiative is funded by a $2.5 million grant from the New York-based Markle Foundation-of which Diamond is the managing director-and another $375,000 from the Robert Wood Johnson Foundation. The preliminary report had been scheduled for release in July even before HHS pegged its coming-out event on IT adoption to this week's Washington conference, Diamond said. But with the exact timing of the report's release, the coaltion seized the opportunity "to be supportive of the current (federal) initiative," she said.
Connecting for Health already has a track record of moving the IT issue forward through broad consensus among its more than 100 prominent representatives of providers, payers, patients, accreditors, government agencies, researchers and information systems manufacturers.
In September 2002, it rallied around a set of common standards for electronic health records, communication with pharmacies, clinical laboratory results and transmission of data from medical equipment to information systems. Six months later the federal government threw its weight behind the same set of standards, which marked the beginning of its leadership role in healthcare IT adoption (March 31, 2003, p. 10).