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Jump-Starting Health IT: An Open Letter To President Obama And Congress



February 3rd, 2009

Editor’s Note. Below, Mark Leavitt, chair of the Certification Commission for Healthcare Information Technology, addresses an open letter on health information technology to President Obama and the new Congress. Health IT is also the topic of Health Affairs‘ upcoming March-April issue, which will be released on March 10. 

President Obama and members of Congress: 

Please accept my heartfelt congratulations for recognizing health information technology (IT) as one of the most promising targets for public investment at this crucial moment.

As a (formerly practicing) doctor, I’d diagnose our economy on the verge of a Code Blue, and our health care system with a more chronic but equally threatening condition. You’ve recognized how these two illnesses interrelate, with spiraling health care costs damaging business competitiveness and job losses threatening health care coverage. If I may offer a second opinion, I concur 100% with your decision to apply the chest paddles now, charged with $20 billion of investment in health IT.

Now I would like to offer this promise: I and my fellow health IT leaders are passionately committed to ensuring that this treatment not only succeeds, but delivers a substantial positive return far exceeding the amount invested. How can we be so confident? Well, even a 1% improvement in the efficiency of our $2.2 trillion health care spending would put us in positive payback territory. But we can do better than that, and here’s why.

Health IT Products Are Ready Right Now

I chair a nonprofit organization that tests and certifies health IT products, so I’m very familiar with the state of that industry and the behavior of potential purchasers. In the past three years, we’ve certified over 160 electronic health record (EHR) products for doctors’ offices, hospitals, emergency departments, and more. We rigorously check not just what the software can do, but also for interoperability — the ability to share information with other providers — and the security of the systems as well, all against established standards. Most doctors know they need EHRs, and many will respond to an economic push right now. And the industry supplying those EHRs is a competitive, diverse marketplace that will respond to growing demand with increased capital investment and job growth.

We’ve Learned How To Structure Incentives Toward The Desired Outcomes

Nobody is advocating a massive, unqualified handout of dollars to doctors. Outright grants may be appropriate for providers in rural and underserved areas, and for safety-net clinics, but in other environments, financial incentives should be structured as a series of incremental rewards for progressive achievements. In the private sector, the Bridges to Excellence program sets an excellent example, while the recently launched Medicare EHR Demo provides a public-sector prototype. These programs offer initial incentive payments for purchasing appropriate technology — a certified EHR — and then a second round of money when successfully implemented. Beyond that, bonuses are paid only as the provider demonstrates improvements in quality or efficiency. Health care payment reform and health IT — twins separated at birth — must grow up and mature together to achieve their full potential.

An Investment In Human Capital

Every experienced IT hand knows that technology is just a tool and that returns on IT investment require strong leadership and dedicated change management. So some of the stimulus funds should be used to develop the skilled workforce needed. It may be possible to redeploy IT personnel from other industries to lay broadband infrastructure for health care, but we’ll also need to boost health IT training programs. And doctors and nurses being asked to change their habits are best motivated by one of their own –a clinician champion. There are plenty of clinicians who have successfully led these projects, and we can’t afford to have their experience locked up within their own organizations. Let’s find a way to put them on a health IT inspirational speaking circuit.

Empowering Patients

You’ve also wisely recognized the need to redirect our health efforts toward prevention, helping people make better choices early in life and eventually reducing the burden of expensive interventions near the end. To do this, we need to empower citizens with health knowledge, allowing them to make better health choices and to become more discriminating health care consumers. Personal health records (PHRs) will emerge as a platform for this new information flow. The organization I lead is also preparing to certify these PHRs, to ensure that they are secure and private and can exchange information with EHR systems in doctors’ offices and hospitals. Projects in this field are a promising area for government investment.

The Final Frontier: Health Reform

You’ve recognized the need for dramatic improvements in health care, but you’ve decided not to attempt a radical rip-and-replace approach. That’s a wise choice. In many towns, hospitals themselves are the major source of jobs; a massive disruption could even shut them down and further weaken the economy.

Fortunately, almost every illness of our current model is amenable to improvement with an assist from better information. With better data on prices charged and quality of care delivered, we can reform payment to reward clinicians for the quality or their work, instead of just for the quantity. With EHRs that easily intercommunicate, we can reward better teamwork among providers to re-integrate care despite our fragmented health care business model. And with empowered health consumers and an online connection that extends beyond the occasional visit to the doctor, we can motivate healthy lifestyles and prevention, eventually reversing the growing burden of chronic diseases.

We’re Charged Up: Just Push The Button

Finally, I see that you understand what is needed to revive our economy: an injection of fiscal stimulus, a steady dose of inspirational leadership, and a big response of energy and optimism from the American people. So you will be pleased to hear that the health IT community is charged up with those qualities right now. At our organization, just one of several initiatives in health IT, we’ve seen some two hundred unpaid volunteers serve tirelessly for over three years, and they’re ready to do more.

Paddles: charged. Pathway: clear. Just push the button, and a new vital rhythm in health care will begin.

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3 Responses to “Jump-Starting Health IT: An Open Letter To President Obama And Congress”

  1. JD White Says:

    I am curious what Dr Leavitt considers the skilled workforce we need to implement IT ? is is help desk people ? programmers? educators ? systems installers ? clinician (MD and RN) champions ? what would their skill sets, degree/education, and training pathways be ?

    (PS–I’m wondering if it makes sense to cannibalize our already inadequate physician workforce re: numbers at a time we have a developing physician shortage and a demographic tsunami of aging baby boomers developing diseases ?)

  2. C Kennedy Says:

    Interoperability: The Health IT Solution

    Mark Leavitt’s letter to our leaders in Washington touches on an important aspect of health IT missing in recent legislative talks – interoperability.

    While moving to electronic medical records is an important first step towards improving the health care system and reducing spending, reforming health care through information technology will take more than converting paper file cabinets to electronic ones. Our patchwork system of health information exchange cannot, and will not support the required transformation of U.S. health care. An electronic medical record in the absence of connectivity and sharing of clinical knowledge is a bridge to nowhere.

    The Obama administration and Congress have acknowledged a health information technology gap through the HITECH Act, a $20 billion health information technology investment included in the economic recovery package. Yet, much of the dialog in Washington surrounding how to spend these dollars has centered solely on digitizing physician office records and fails to mention interoperability. Investments must require combining a patient’s medical, pharmacy, and laboratory information and deploying this integrated health record to the patient’s entire care team. Research has projected this type of “informed” health information technology system could save more than $160 billion annually.

    The HITECH Act investment must connect physicians, patients, and health information to better inform health care decisions…at the hospital, in the emergency room, and in physician offices across the country. With an aging population and rapidly increasing shortage of primary care physicians, our country must invest in a health information system that delivers a patient’s complete health record at the point-of-care to guide better informed decision making by physicians and patients.

    Charles Kennedy, MD
    Vice President, Health Information Technology
    WellPoint, Inc.

  3. acavale Says:

    Dr. Leavitt:

    I have read this letter both at EHR Decisions and Health Affairs, and concur with a lot of what you have mentioned. However, being an EMR user for nearly 7 years in solo clinical practice, I beg to differ on some of the suggestions. For example neither BTE nor the Medicare EHR Demo programs are appropriate for small practices that wish to provide evidence of high quality, value-added care using IT (a lot more IT than just EMR). CMS has completely ignored small practices in all its demo projects. BTE is far too complicated and expensive for a solo practitioner to complete.

    Although I pushed for and got my EMR to be CCHIT certified in 2006, most practicing physicians have a very poor opinion about CCHIT. They believe that it is too expensive for small vendors to certify (including many physicians that have developed their own software that meets their practice needs better than CCHIT-certified products). They also see an intrusion into privacy and a potential liability issue when CCHIT mandates that software be able log every entry in an EMR. Unless these concerns are appropriately addressed, physicians will be very unwilling participants in the health IT structure. Furthermore, having seen multiple EMRs I still don’t believe that IT serves the needs of medicine as well as it should. Further, the costs of achieving interoperability are just not within the budgets of even large organizations, let alone small ones.

    My challenge to the new government is:
    Can you make interoperability happen without mandates?
    Can you establish a level playing field between physician practices and IT vendors?
    Can you create or modify regulations that will facilitate linking of IT systems of hospitals with those of physician offices?
    Will CMS ever recognize the value of non-face to face physician-patient interaction using IT and reimburse appropriately for such services?
    Is CMS willing to get rid of the rigid CPT structure that makes no sense in the 21st Century?

    My final (and perhaps most important but least plausible) wish is: will physicians ever be able to work in a true free market system where each service can be priced based soley on its value to the individual receiving such service, without the current method of price-fixing by the government? I truly believe that such a drastic action will separate out those that provide timely, value-based care from those that just provide volume-based services. It will eventually lead to substantial reductions in utilisation of services as well as improvement in physician-patient relationships.

    Finally, I agree with the idea of a “clinican champion”. Based on my own experiences – trying to informally help other physicians evaluate IT, I believe I could easily play such a role since I have operated an electronic office for nearly 7 years, and set local standards for care coordination and effective chronic disease management. However, highly paid “consultants” appear to have a stranglehold in this arena due to their expertise in the technical jargon, so physician-champions are left out in the wilderness. I am also wary of what government involvement in all this will bring. Would love to see if the President replies to your letter.

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