j e s r u s h . c o m

The new act contains a bunch of things interesting to those involved in healthcare information systems, and the best way to get up to speed is probably to read this from the New England Journal of Medicine. Following is a short clip:

Although the federal government has long spent billions on health care, there is no precedent for the act’s massive investment in accelerating the adoption of health information technology — or for the expanded leadership role that government will assume in this arena. At present, perhaps only 17% of U.S. physicians and 8 to 10% of U.S. hospitals have at least a basic electronic health record system. Far fewer have — and routinely use — the types of comprehensive systems that would allow them to fully realize the potential of the technology.3 However, such technology will lead to improvements in the quality of care and savings on other health care costs only if the implementation is done right.

In 2004, the Bush administration, by executive order, created the Office of the National Coordinator for Health Information Technology as part of the DHHS. But Congress had never established the office in law, and its funding has been only about $60 million a year. The stimulus legislation codifies the national coordinator position and office, provides $2 billion for discretionary spending, primarily for grants and loans, and sets a goal of “utilization of a certified electronic health record for each person in the United States by 2014.” It establishes two federal advisory committees on health information technology — one on policy and one on standards — through which the government will work with the private sector and consumer groups to develop the specifics of a nationwide health information network. These include the design of “interoperable” electronic health records that permit the seamless exchange of data among physicians, hospitals, laboratories, pharmacies, and other health care organizations, as well as methods for ensuring the privacy and security of patient data. Standards are to be developed in 2009 and tested and certified in 2010; the DHHS will certify specific products.

Beginning in 2011, Medicare and Medicaid will provide financial incentives over multiple years of up to $40,000 to $65,000 per eligible physician and up to $11 million per hospital for “meaningful” use of health information technology, such as the electronic exchange of data and reporting of clinical quality measures. Starting in 2015, physicians and hospitals that do not use certified products in a meaningful way will be penalized. The Congressional Budget Office projects that the incentives will boost the proportions of physicians and hospitals adopting comprehensive electronic health records by 2019 to 90% and 70%, respectively, from the 65% and 45% that would be expected to do so anyway.

Meanwhile John Halamka has some good thoughts on achieving EHR implementations through regional centers.

Janet Rae-Dupree has a good article over at the NY Times about the problems of modern health care and the promise of integrated technology. She writes:

Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy.

But technology is changing that.

Some health care suppliers have set up fixed-fee integrated systems, and accept monthly payments from members in exchange for a promise of cradle-to-grave health care. Each usually also charges a small co-payment for treatment. Routine cases are handled through lower-cost facilities, leaving more complicated cases to higher-cost hospitals and specialists. Such systems include Kaiser Permanente, Intermountain Healthcare in Utah, the Mayo Clinic, the Geisinger Health System in Pennsylvania and the Veterans Health Administration.

By creating a continuum of care that follows patients wherever they go within an integrated system, says the Princeton University economist Uwe Reinhardt, care providers can stay on top of what preventive measures and therapies are most effective. Tests aren’t needlessly duplicated, competing medications aren’t prescribed by different doctors, and everyone knows what therapies a patient has received. As a result, integrated systems like Kaiser’s provide 22 percent greater cost efficiency than competing systems, according to a 2007 study by Hewitt Associates.

Beautiful. The bones of KP’s system is Epic.