One of the more creative provisions in the American Recovery and Reinvestment Act’s $19 billion health information technology (IT) initiative calls for the creation of “regional extension centers” to “provide technical assistance and disseminate best practices . . . to support and accelerate efforts to adopt, implement, and effectively utilize” health IT. Simply put, the Office of the National Coordinator for Health IT is charged with fielding geek squads to help small physician practices, community health centers, and others handle the difficult tasks of choosing, buying, installing, and learning to use new IT tools.
Given that many studies have highlighted the complexity of IT adoption, this is a good idea. Even better, we now have convincing evidence that it works. At a March 10 briefing on Health Affairs’ new special issue on health IT, Farzad Mostashari of New York City’s Primary Care Information Project (PCIP) described his project’s hard-won victories in IT adoption at 163 urban health facilities. Integrated health systems like Kaiser Permanente have shown that they can do “amazing things” with electronic health records (EHRs) and other IT tools, Mostashari said. What remains to be seen is whether process improvements like those documented in KP articles in this journal’s current issue (on Hawaii and KP’s national patient health record) can be exported to the Hobbesian world of small-practice, fee-for-service medicine outside the alternative universe of integrated plans.
The theme of exportability was picked up by another presenter at the briefing, Jim Walker, who represents the integrated world as chief information officer at Geisinger Health System and was both an author of an article in the IT issue and its guest editor. Echoing a common theme at the briefing, Walker emphasized that IT is a means to an end — better and more efficient care — and not a goal in itself. At Geisinger, he explained, IT is used to support a system of breaking down care processes into discrete steps that can be baked into a provider organization’s modus operandi. Where best practices can be agreed on, he said, these subprocesses can be codified and theoretically disseminated to providers who are not part of KP- or Geisinger-like systems. The Geisinger organization itself has also experimented with exportation by sharing its EHR system with nonmember physicians’ practices in its north and central Pennsylvania service area. But some of its care-process protocols might also be exportable to organizations like Mostashari’s.
A packed audience at the Health Affairs briefing testified to the excitement that the stimulus legislation has generated in the health IT community. Cerner Corp. CEO Neal Patterson compared the waves of enthusiasm to an old-fashioned Oklahoma land rush. But several speakers reflected an underlying anxiety about the possibility that stimulus dollars will be squandered and opportunities to advance the IT agenda lost by trying to spend too much money too fast.
These concerns were also vented in several Perspectives published online by this journal on March 9. Former national IT coordinator David Brailer warns against heavy-handed government intervention in the delicate business of technological innovation. John Halamka and Mark Frisse emphasize the virtues of strategies that don’t try to do everything at once. Underscoring their message were other papers in the March/April issue that documented slow progress in the implementation of Medicare’s e-prescribing initiative — once regarded as “low-hanging fruit” — and in the development of regional health information exchanges (RHIOs).
But Patterson’s land-rush metaphor seemed to capture the audience’s imagination. Hold onto your hats, that image said. It’s going to be a wild ride.