Part one of a two-part series:
The Office of the National Coordinator for Health Information Technology at HHS last week released an updated version of a national healthcare IT promotion plan that will give healthcare leadersand members of Congressa clear list of national goals and a better way to track progress toward meeting those goals.
The 115-page update of a 2004 national healthcare IT development plan covers five years, through 2012. It lays down 43 points of measurement, or strategies, across four broad themes of development, or objectives, to achieve two key national goalspromoting what it describes as patient-focused healthcare through the use of electronic health information, and adapting that technology to also improve public health, medical research, healthcare quality improvement and national medical emergency preparedness.
The four objectives, similar for both goals, are: promoting widespread adoption and use of IT systems, achieving interoperability between systems for the exchange of data between healthcare organizations, ensuring trust in electronic healthcare information exchange by maintaining privacy and security, and establishing structures of collaborative governance for those exchanges.
Healthcare industry IT experts contacted for this story almost universally praised the plans broad scope and thoughtful organization, but some said it was not forceful enough in pushing for adoption of healthcare IT systems, particularly by office-based physicians, and several said it should have done more to marshal federal financial resources to achieve its goals.
I absolutely do think it is a great roadmap for the task at hand, said Brett Furst, vice president of healthcare for Covisint, a subsidiary of Compuware Corp., Detroit, a developer of a Web-based interoperability platform for use by healthcare information exchanges. I think the categories; privacy, security, interoperability and adoption are spot on. The issue is, How do we execute the plan?
Im going to take the high road on this and give it a thumbs up, said Rod Piechowski, senior associate director of policy for the American Hospital Association. Piechowski, along with others, said that he was particularly impressed with a section of the plan that listed existing federal healthcare IT programs.
The plan was lauded as comprehensive by physician informaticist Harris Stutman, executive director of clinical informatics at the six-hospital, 1,515-bed Memorial Health Services system based in Long Beach, Calif. At a general level, this is going to be a very useful document in terms of organizing our thought processes and ultimately plans of action dealing with many diverse priorities that interrelate, he said.
If there has been one major concern about what has happened in HIT strategies since the ONC was created, its that the milestones, the goals, havent been very well-defined, Stutman said. The way that the folks at the ONC have laid out the grid of objectives and strategies as they support the two overriding goals is going to be very useful. Its very nicely done.
I guess if I had any criticism, Stutman added, it is the milestones often dont push the boundaries.
For example, he pointed to one benchmark that called for a majority of health IT systems to be certified by the federally supported Certification Commission for Healthcare Information Technology by 2010.
That seems like a not terribly aggressive strategy, Stutman said. I would hope that almost all of the vendors are already certified or seeking certification. We can do a lot better than that.
Setting somewhat more challenging milestone goals would have been entirely in order, Stutman said. Im certainly hopeful, as we approach the milestones established (by the plan), we will take that as an absolute floor of what we can achieve in terms of interoperability, adoption and privacy and security.
Physician entrepreneur Andrew Ury is vice president and general manager of McKesson Practice Partner, Seattle, an electronic health-record system developer he founded that was acquired by McKesson Corp. in 2007. Ury also served as co-chairman of the Electronic Health Record Vendors Associationan arm of the Healthcare Information and Management Systems Societyand said that overall, the latest ONCHIT plan seems reasonable.
The strong points are the emphasis on EHR adoption and interoperability, Ury said. On the other hand, the overall adoption goal was low.
In 2006, the EHRVA drew up its own national Interoperability Roadmap. The group was critical of what members saw as an overemphasis by HHS and ONCHIT on regional health information organizations, or RHIOs. The association plan advocated instead a more pragmatic business case-oriented approach to planning of a national health information infrastructure around incremental improvements that provide immediate benefits.
The new ONCHIT plan sets a target of 40% of physician offices using certified EHRs by 2012, but lowers the bar to just 12% EHR usage by 2012 for those working in offices with five physicians or fewer, a size in which a clear majority of office-based physicians practice.
Stutman said that the impact of the ONCHIT plan at the provider level is a little trickier for an organization like ours that is really moving very aggressively in these efforts. Memorial Health Services is four years into a clinical IT program that should be completed with an EHR rollout at the last of its six hospitals next year, he said.
Whats in this document isnt going to change very much what were doing, Stutman said. Memorial is currently a member of the Long Beach Network for Health, a developing regional health information organizationone of nine nationally to receive startup funding from ONCHIT.
In the sense that we dont exist in a vacuum, that Memorial is part of a community of providers seeking to exchange patient information, I think this will make life easier for all of us. Were operating off the same playbook, Stutman said.
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