A report highlighting the failure of many regional health information exchanges was Health Affairs’ most-read article in December. Then in January, the California HealthCare Foundation (CHCF) published another discouraging assessment on the progress of these collaboratives and of the national infrastructure envisaged in the 2004 presidential order that called for wiring the health system in ten years and created the Office of the National Coordinator for Health Information Technology. 

The twenty-five-page CHCF report was written by Bruce Fried and is based on interviews in mid-2007 with about two dozen thought leaders from the health information technology (IT) community. A characteristic comment, by Charles Kennedy of WellPoint: “The problem with RHIOs [regional health information organizations] is no one has figured out how to specifically connect them to the existing business model of health care. So they’re kind of this entity that’s hanging out there that doesn’t really have a role in what we would call the value chain.” The national health infrastructure, “was a disaster from the beginning,” said Bill Braithwaithe, vice chair of the Healthcare Information Technology Standards Panel. 

But while regional collaboratives and the information superhighway have been slow to meet the expectations of their designers, enthusiasm continues to bubble up for bootstrap efforts to meet information-sharing needs as they occur, from the bottom up. “There are some core problems like identification, merging, consent, technology standards, that we have to take on simply to take care of us,” said Vanderbilt University informatics professor Mark Frisse, who is bullish on the progress of the three-county MidSouth eHealth Alliance in Memphis, which he directs. 

Similarly, cautionary tales in this journal about health IT adoption by physicians have attracted widespread reader interest (Ashish Jha et al., for example, and Robert Miller and Ida Sim). But while full-suite electronic health record products are getting traction in small physician practices at only a snail’s pace, David Kibbe of the American Academy of Family Physicians reports that doctors are experimenting increasingly with component products and services that meet immediate needs, such as Web-based scheduling applications, e-prescribing, or patient e-mail. 

SureScripts’ December report on e-prescribing, for example, found that more prescriptions were transmitted in the first three quarters of 2007 than in 2004, 2005, and 2006 combined. The thirty-five million scripts routed electronically in 2007 was only 2 percent of total prescription volume in that year, but a hundred million e-scripts are expected in 2008, growing the share sharply to 7 percent. With a legislative mandate, presumably, the pace accelerates exponentially. 

Just as noteworthy, perhaps, was a February 4 story in the Los Angeles Times reporting that both Aetna Inc. and CIGNA Corp. have recently announced plans to begin reimbursing doctors for e-mail or other forms of electronic communication with patients. Some integrated delivery systems like Kaiser Permanente and the Geisinger Health System already have this capability. But extending this frontier into the fee-for-service wilderness could be a game-changing event. 

Infrastructure needs such as standards and privacy policy still need plenty of attention, former congressional staffer Michael Zamore told Fried, referring to some of the more difficult issues that have faced RHIO developers. But “there’s a tremendous potential in unleashing consumer demand for IT,” Zamore said. “People are leaving patients out of the conversation.” 

Health Affairs’ next special issue on health IT is planned for March 2009, under the working title of “HIT: Patients, Practice, and Policy.” A call for abstracts is currently in circulation.