HHS needs to add detail and measurement points to its plan for creating a national healthcare information system, according to a new report by a government watchdog agency. In the meantime, two healthcare foundations pledged to contribute more than $1.9 million to help establish a key element of that national system.
The Government Accountability Office in late May issued a 92-page progress report on HHS efforts to promulgate healthcare information technology, compiling a long list of government and private-sector IT initiatives. But the GAO, a government watchdog agency that reports to Congress, found something to criticize in HHS' efforts so far.
Despite its lengthy Framework for Strategic Action, a national IT blueprint released last summer by HHS' Office of the National Coordinator for Health Information Technology, the agency still "has not made long-term plans or established milestones for the implementation of a national strategy to accelerate the adoption of IT across the healthcare industry," according to the GAO.
The government investigators also noted HHS would do well to study the successes of the Defense and Veterans Affairs departments for "important lessons learned" from developing their global and national clinical IT systems. The GAO advised HHS that the deployment of national healthcare IT systems in Canada and Denmark and a proposed system in New Zealand could create additional learning opportunities.
The GAO report acknowledged that the national coordinator, physician David Brailer, "has made progress toward coordinating federal health IT efforts and reaching out to private industry."
Meanwhile, the Markle Foundation and the Robert Wood Johnson Foundation announced last week that they are funding the regional interconnectivity project, organized by Connecting for Health, a not-for-profit coalition founded and managed by Markle and supported by the Johnson foundation, whose 100 members include government and healthcare industry organizations promoting healthcare information technology.
The experimental effort will attempt to establish a framework of operating principles and technical standards for linking patient information among regional healthcare-information organizations, or RHIOs, in California, Indiana and Massachusetts.
The three participating RHIOs are the MA-SHARE network based in Boston; the Indiana Network for Patient Care in Indianapolis; and Mendocino SHARE, a patient information-locator service based on open-source software in Northern California's largely rural Mendocino County. SHARE is an acronym for securing health access and records exchange.
Brailer is pushing RHIOs as a basic building block of a national healthcare information infrastructure. A Connecting for Health statement dubbed its three-RHIO project "the first step" in creating that national system.
Markle Foundation President Zoe Baird, at a news briefing last week, called it a "shame" that healthcare still lags behind other U.S. industries in the adoption of information technology.
The Markle initiative will use the Internet as the vehicle for the proposed data interchange, Baird said. Internet use will enable patients and other healthcare consumers to have easy access to medical information, she said.
John Halamka is chief executive officer of MA-SHARE, launched by five Massachusetts healthcare groups as an extension of an earlier pilot.
Under the pilot program, emergency room physicians at participating hospitals could tap into the databases of several Massachusetts health plans and prescription benefit managers to view the medication lists of their patients. MA-SHARE will allow participants to share an expanded menu of healthcare information.
The ultimate goal of MA-SHARE is to provide connectivity for 5,000 care providers, who serve 2.5 million Massachusetts patients.
"Once you have the infrastructure in place, it's pretty easy to scale up to cover the whole of the state," said Halamka, chief information officer at Harvard Medical School and at CareGroup Health System.
J. Marc Overhage, CEO of the Indiana Health Information Exchange and a physician and senior researcher at the Regenstrief Institute, said connecting the three regional data-exchange programs "is, in fact, an approach that would enable and be consistent with the so-called RHIO model."
The Indiana exchange, founded last year, is attempting to extend the data-sharing technology developed by Regenstrief over more than a decade to five founding hospital systems operating in and around Indianapolis.
Will Ross is project manager at Mendocino SHARE, which in two weeks will begin exchanging chronic disease-management data among five small community-health clinics staffed by two to 10 physicians.
The three small hospitals in the county, which combined have fewer than 200 beds, will be hooked up to the exchange next, Ross said.
"We're trying to look at this from the perspective of what an information interchange will look like at the small, rural office model," Ross said.
Brailer's July 2004 national IT blueprint outlined four key national goals: introduce computerized information tools to clinical practice; connect clinicians using these tools; use IT to personalize patient care; and use IT to improve population health.
The plan will be enacted in three phases, the first of which is under way -- developing market institutions to create a better environment for IT investment.
The second phase encompasses actual investment in IT systems, and the third calls for supporting the transition to a healthcare market in which providers are rewarded and held accountable for quality.
The GAO recommended that HHS develop "detailed plans and milestones for each phase of the framework" and "take steps to ensure that plans are followed and milestones are met."
The GAO further noted that "without defined milestones, it remains unclear when the important activities of phase I will be completed and when the building blocks to support activities of the subsequent phases will be available."
Brailer's office declined a request for comment on the GAO report.