March 10, 2009
12:01 a.m. Eastern Time
Health Affairs Series On Health IT And Economic Stimulus Plan Offers Lessons Learned, Potential Roadblocks To Adoption Amid Massive Federal Investment In Health IT
Bethesda, MD -- With the enactment of the American Recovery and Reinvestment Act of 2009, the U.S. government is set to spend $19 billion to expand use of electronic health records (EHRs) and other forms of information technology (IT) in health care. Now a series of articles on the Health Affairs Web site offers perspectives on how to spend those stimulus dollars wisely -- and with a keen eye to improving health and health care worldwide. http://content.healthaffairs.org/cgi/content/full/hlthaff.28.2.w379/DC2
David Brailer, M.D., who served as the first National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services from 2004 to 2007 shares lessons from health IT efforts during the administration of President George W. Bush. Brailer also offers guidance for the administration of President Barack Obama as it implements HITECH, the health technology portion of the stimulus package. Although Congress’ move to allocate $19 billion for the adoption of EHRs is a step in the right direction, Brailer highlights problems that the administration must tackle to prevent roadblocks to data exchange, avoid increased costs, and reinforce patient-centered care. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w392
"More than any other factor, the forthcoming actions of the Obama administration will determine whether health IT fulfills its promise for improving health care -- or whether it is merely today’s taxpayer-funded high-technology bonanza," writes Brailer, who now leads Health Evolution Partners, an IT and health services firm in San Francisco.
EHRs alone will not improve the quality and efficiency of care. Health reform will require "useful, valid, and portable health information" that comes from careful planning and an "orderly evolution of technology," he writes. Brailer calls on the Obama administration to balance private and public leadership in the area of health IT standards, strike a balance between the need to protect privacy and make information portable, and ensure that incentives go to hospitals and other facilities that cannot afford and do not have EHRs in place. Providing incentives for those facilities to adopt health IT "would have closed a growing digital gap between the haves and the have-nots, and it would have truly stimulated job growth in both rural and inner-city markets, where the stimulus is most needed. Unless the administration can recalibrate this incentive, this is a lost opportunity that will eventually need to be addressed," Brailer concludes.
In another Health Affairs Web-Exclusive Perspective, John Halamka, chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center, offers five guiding principles for speeding adoption of EHRs that build on previous work and avoid misspending economic stimulus and recovery funds. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w385
Halamka calls for:
Mark Frisse, director of regional informatics at Vanderbilt University, offers another Perspective. He writes that an opportunity will be missed if health IT simply automates a broken system. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w379
"Those charged with policy-making responsibilities must choose among realistic, incremental efforts and paradigms that are noble in aspiration but unrealistic in practice," he writes. "We cannot predict how legislative intent will translate into meaningful outcomes. We can only commit to learning from the past."
Taking a global view, Ticia Gerber, senior advisor at Manatt Health Solutions,highlights the common threads in national and global health IT discussions. These include the need for strong stakeholder engagement, funding and donor coordination, and agreement on standards and interoperability. "As the United States positions itself to undertake major federal investments in health information technology, we should resist the temptation to look only within America’s borders for advice or wisdom on how best to do it," she writes. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w390
Gerber calls for a portion of the economic recovery package’s health IT money to be used for examining health IT projects and critical lessons learned from around the world. She suggests launching at least one multinational health IT demonstration that involves developing countries. In addition, she emphasizes the importance of strategically engaging international consensus organizations and other diverse groups to ensure workable health IT policy and systems that can communicate across borders.
After the embargo lifts, you can read the paper by Frisse at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w379
You can read the paper by Halamka at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w385
You can read the paper by Gerber at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w390You can read the paper by Brailer at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w392
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