A plan for advancing health information technology, unveiled last week by HHS Secretary Tommy Thompson and his national IT coordinator, succeeded in brokering cooperation between the federal government and the nation's providers, payers and healthcare purchasers-and committed to applying existing federal resources to lessening barriers to adoption of electronic medical records.
However, the enhanced federal leadership role detailed at a Washington summit meeting did not include pledges of substantial new IT funding sources for strapped hospitals and physician practices; many in the industry say such funding is needed to pay for costly software and support its effective integration into clinical environments.
A 33-page outline of broad goals and near-term activities authored by David Brailer, HHS' national coordinator for health IT, focused on the needs of physician practices, from exploring "shared investments" in electronic records to determining ways to reduce physicians' risks of purchasing clinical systems-both major barriers. Brailer also said special attention would be paid to hospitals and doctors in rural and other "underserved" areas.
Despite the focus on physicians, the lack of more substantial news on new funding in the so-called "framework for strategic action" left some physician groups wanting more.
For example, the Medical Group Management Association said any strategic plan for widespread penetration of clinical IT will need "greater recognition of the need for financial incentives," said William Jessee, president and chief executive officer. "Physician practices will adopt information technology only if they can afford the significant cost of new hardware and software for electronic capture and storage of patient-care information."
But others said deficiencies in ambulatory-care IT systems, combined with an inadequate ability to connect with other computerized information sources, will limit interest even if subsidies for purchase and implementation costs were available.
"We have a lot to do to make these things workable," said Scott Wallace, president and CEO of the National Alliance for Health Information Technology. "What are you going to (offer an incentive for): Systems that aren't interoperable?"
Industrywide efforts would be better spent on fixing these product-related problems first, Wallace said, because physicians are often not persuaded that the initial practice costs and ongoing expense of maintaining such systems are worth it. "There's an economically rational behavior going on and we have to fix it," he said. "They're not (given an incentive) to buy IT because they don't get the benefits."
Hospitals and healthcare systems that can afford the capital commitment are beginning to allocate millions of dollars to the goal of clinical computerization and its promise of efficiency and patient safety. But they're finding that the prospects for clinical IT investments by their referring physicians-which would complete the information loop-are impeded by both the prohibitive costs of ambulatory-care systems and the inability of such systems to connect with those in hospitals even if physicians could afford to buy them.
Three years ago, Trinity Health of Novi, Mich., launched a $300 million project to automate and reorganize clinical operations at 23 hospitals in 17 locations from Silver Spring, Md., to Fresno, Calif., said Mary Trimmer, vice president of the initiative called Project Genesis.
The first facility in the project, 119-bed Mercy Hospital in Port Huron, Mich., started operating the set of new clinical systems 14 months ago. A large proportion of the 220 doctors on staff now have access to information from hospital IT systems through an Internet connection and are able to enter orders, retrieve test results and complete their documentation online, Trimmer said. "But the converse is not true," she said; the hospital cannot get information on patients from their physicians unless the practices install a system to automate their clinical operations, and only a few have done so. None of those physician-office systems are capable of communicating with the hospital's systems, she said.
Physicians most often said the cost was the prime reason for not making the investment, though they also see it as risky as well as costly, Trimmer said. They don't want to buy a system and not have the ability to connect with the hospital and other outside facilities such as laboratories-and they worry that it "could be obsolete in a month," she said.
Brailer said his office is exploring a range of incentives to foster IT adoption, including a push to reward clinicians for delivering superior care. CMS Administrator Mark McClellan last week reiterated the Medicare agency's aim to move to a "pay for performance" strategy, and several business coalitions already have started distributing payments based on private-sector programs in several cities.
But payment for performance won't catch on until physicians can do the necessary patient-tracking and documentation of rewardable outcomes that only IT systems can enable, some advocates for incentives observed.
The bigger challenge
Though the focus of IT adoption has been on large institutions and healthcare systems, "the greater challenge in this market is in getting physicians in small- and medium-sized practices to adopt this important technology," said Douglas Henley, executive vice president of the American Academy of Family Physicians, who was among several physician representatives reacting to Brailer's report. Noting that payers are the likely beneficiaries of the bulk of an estimated $100 billion in annual savings from clinical IT if universally adopted, he recommended that Brailer "make the case for strong financial incentives from payers to physician practices," which "should not exclusively be about pay for performance" but also include "the challenges of implementation, both financial and nonfinancial."
A new coordinating organization for payers and large employers last week arose to take up the task of deciding among themselves "the core of what we're going to pay for" to encourage IT adoption, said Francois de Brantes, program leader for healthcare initiatives at General Electric Co.
Formed the weekend before the July 21 summit meeting, the National Alliance for Health Care Information Technology Advancement gave itself 90 days to arrive at a common set of mechanics to govern not only programs rewarding superior outcomes but also IT "pay for use" programs, de Brantes said.
Participants in the alliance, which represents nearly 200 million people covered by health insurance, include four coalitions of purchasers seeking to influence quality of healthcare: the Leapfrog Group, the National Business Group on Health, the National Business Coalition on Health and Bridges to Excellence, a coalition that administers pay-for-performance programs.
Also in the alliance are two major payer organizations, the Blue Cross and Blue Shield Association and America's Health Insurance Plans. Two physician groups, the AAFP and the American College of Physicians, make up the physician representation.
Recognizing that the use of IT is a prerequisite for generating superior outcomes, the alliance plans to define what triggers an incentive payment, de Brantes said. For example, a physician office should not only have an acceptable electronic medical record but also be able to demonstrate that it can generate a report of patients by chronic condition and what was done during their most recent visit, he said. Hospitals would be included in the plans for performance rewards but probably not pay-for-use programs, he added.
But the alliance also wants to ensure that government and providers pay their share. For example, "If we're going to foot 60% of the bill, we expect Medicare to foot the other 40%," he said. Before it decides to pay for IT, the alliance will have to establish "mechanics to agree upon so we can minimize the potential for free rides," de Brantes said. "No one wants to create a massive free-ride potential."
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National technology goals
Inform the clinical practice of medicine
-Bring IT to the point of care through investment in electronic records
-Build an interoperable information structure giving physicians and patients access to critical data when decisions are being made
Personalize care for consumers
-Use health IT to give people more access to and involvement in health decisions
Improve population health
-Expand capacity for public-health surveillance, quality-care measurement and quicker introduction of research advances into medical practice
Source: Modern Healthcare reporting