Guest commentary from Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), a non-profit standards-development and accreditation organization.

Information technology has been mature enough to transform health care for years. The HITECH Act has now cemented the business case. The biggest remaining obstacle to achieving the benefits of interoperability -- everything from e-prescribing to truly accessible medical records -- is building trust and confidence among data-sharing partners.

The chief privacy and security threats are already familiar to most: constant breaches, internal snooping and even piratical extortion more creative than what we've seen from Somalia. Clearly, organizations must get their houses in order. But the actions or inactions of their data-sharing partners can also put them at risk with regulators and the marketplace. They need a dose of confidence in the abilities of their application vendors, service providers and peer organizations. Also along those lines, as health care management grows in complexity, organizations are looking for ways to gain assurance regarding technical performance, customer service levels and resource capacity for all business partners.

Health care organizations need a model for controlling risk and vetting data-sharing partners at three levels. The first is the application level. As software moves to the application service provider (ASP) model, by which applications are hosted off-site via Internet, verifying these systems becomes as important as demonstrating reliable technical performance and scalability. The second group is transaction-based service providers, such as claims clearinghouses, e-prescribing services or financial services firms. Beyond assurance that they are HIPAA-compliant and HITECH-ready, provider organizations spend much energy assessing prospective partners' customer support and business processes. Lastly, at the community level, there is a tremendous need for confidence among peers across technical, operational, administrative and all other areas. Regional health information organizations (RHIOs) have an accountability dilemma: No data sharing due to fears about data integrity and no confidence because few have a history of sharing data.

Given the urgent need, what are the industry's options for establishing this accountability? These are discussed in an excellent research paper, New York's Health IT Strategy: RHIO Governance & Accountability. Expanding on that discussion, these are the three main options:

• The laissez-faire or "hands off" approach requires contracts between and among organizations. It's buyer beware. It's also "buyer manage a large number of complex agreements with no practical enforcement mechanism." This model has potential for much litigation.

• The Soviet approach would use central planning and call for hands-on oversight and management by a representative entity (that is, a government agency). To put it mildly, this approach is typically unpopular in the U.S.

• The accreditation approach requires that industry stakeholders work together, through an independent organization using transparent process, to develop standards. This group then confers accreditation on willing organizations. Those who demonstrate excellence use the distinction to their advantage in the marketplace. Accreditation models can be devised that allow flexibility for the candidate in terms of specific tools and methods yet evaluate it against performance standards and criteria that are more results-oriented.

EHNAC -- which gathers consumer groups, payers, hospitals, physicians, security organizations, electronic health network vendors and others to develop standards criteria -- has successfully accredited one type of service provider for years: electronic health networks or, more specifically, claims clearinghouse services. More recently, we have expanded to cover e-prescribing and financial services providers. At the application level, we apply the accreditation approach to ASP-based electronic health records; our beta testing begins in the summer of 2009. At the community level, we're developing an accreditation framework for health information exchange that can be used by RHIOs. That beta program begins in the fall.

We're making great progress, but awareness about accreditation is going to be critical. Provider organizations need to know what accreditation means. They simply need to know to ask the question "are you accredited?" and understand the due diligence that accreditation represents.

As long as provider organizations don't find a satisfactory solution, progress toward interoperability will be delayed. In addition to missing out on productivity, efficiency and quality benefits, health care will continue to rely on paper. And as any quick Internet news search will reveal, paper-based medical records do not necessarily solve accountability problems.

Surescripts made the announcement in conjunction with the release of the company's "National Progress Report on E-prescribing." The report, based on the operations of the Surescripts network, details the status of e-prescribing adoption and use in the U.S. from 2006 through 2008.

Among the report's key findings:

• By the end of 2008, there were 74,000 active prescribers -- vs. 36,000 at the end of 2007 and 16,000 in 2006.
• Prescriber use of benefit information and prescription history grew from 37 million in 2007 to 78 million in 2008, and from 6 million in 2007 to 16 million in 2008, respectively.
• Prescriptions routed electronically more than doubled from 29 million in 2007 to 68 million in 2008.
• By the end of 2008, increased participation by payers in e-prescribing enabled access to prescription benefit and history information for 65 percent of patients in the U.S.
• Seven states are connected to the Surescripts network through their pharmacy benefit managers to deliver prescription information for fee-for-service Medicaid patients.
• At the end of 2008, approximately 76 percent of community pharmacies and six of the largest mail-order pharmacies in the U.S. were connected for prescription routing.

Harry Totonis, president and CEO of Surescripts, commented, "[W]hile this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing."

Surescripts acknowledged that only about 10 percent of eligible prescriptions are currently routed electronically. The company recommends that five actions be taken at the earliest opportunity to continue the growth of e-prescribing use and adoption and to further secure reductions in cost as well as improvements in safety and efficiency:

1) Continue to work with the U.S. Drug Enforcement Administration to pass regulations that allow controlled substances to be electronically prescribed in a way that is workable and scalable.

2) Work to ensure that "meaningful use" under the American Recovery and Reinvestment Act of 2009 requires the actual use of e-prescribing.

3) Fill gaps in e-prescribing participation among payers, state Medicaid programs and independent pharmacies.

4) Raise awareness across the industry and encourage deployment and use of e-prescribing -- encompassing prescription benefit, prescription history and prescription routing.

5) Provide education, financial incentives and implementation assistance for all prescribers, with a particular focus on addressing the needs of small and medium-size practices.

 You can access a downloadable version of the report by visiting www.surescripts.com/e-prescribing-statistics.html.

For example, Absolute Software, a provider of firmware-based computer-theft recovery, data protection and IT asset management solutions, points out that ARRA's incentives will revolutionize record-keeping, making medical records available throughout hospitals on mobile computers, tablet PCs and shared terminals.

"With this accessibility and increased efficiency," the company warns, "health care providers need to be aware of and address the vulnerabilities of such systems to data breaches and theft."

The company's Web site lists five best practices for keeping data secure in the age of ARRA:

1) Know the consequences of a data breach. According to a recent study from the Ponemon Institute, organizations that experienced a data breach in 2008 paid an average of $6.6 million to rebuild their brand image and retain their customers. The study also found that health care companies lost the most business resulting from data breaches compared to any other industry.

2) Assess your organization's situation. Health care managers should properly assess all areas of the facility where confidential data may be stored, then determine who has access to them and how they are being protected. Before an organization can begin to streamline its IT security, it must have a firm understanding of what it needs to protect.

3) Implement a comprehensive data security plan. Even with encryption in place, 56 percent of employees disable their company-issued encryption solution. Security and asset management solutions should be part of a multilayered approach in protecting organizational computers. Absolute Software noted that its Computrace product has the ability to track and recover missing laptops as well as to remotely delete sensitive files. (The software is embedded in the firmware of computers from ASUS, Dell, Fujitsu, General Dynamics Itronix, HP, Lenovo, Motion, Panasonic and Toshiba.) The company also has a product that allows IT managers to monitor and protect smart phones in a similar fashion.

4) Secure data on mobile computers. The more hospitals use mobile computers and PDAs, the higher the risk of theft and data ending up in the wrong hands. A multi-layered approach to data security and theft is necessary to protect these assets.

5) Create a data breach policy. In the event of a data breach, a standard procedure should be in place to minimize damage and provide timely notification of supervisors, law enforcement, patients and the media, as necessary.

Pulling together as a nation to overhaul an aging, often paper-based medical records system is long overdue. We can all agree it will create jobs, pump money into various industries and make managing a fast-growing patient base much easier. With great potential comes great risk -- in this case, risk of stretching an ailing health care IT industry to the breaking point. Legacy systems abound, support for decade's-old central infrastructure no longer exists, and facilities must consider increased privacy and regulatory measures.

Clearly, outsourcing is the most attractive solution within an economy of reduced IT budgets -- a solution that can be greatly improved for the betterment of all involved with the planning and building of EMRs. As a theme, "risk" often starts with traditional outsourcing arrangements emphasizing getting to the lowest bid...as opposed to getting to the best business value. The health care IT industry needs this to change. In my opinion, this change should follow a few basic guidelines.

1) Outsourcing should generate a favorable return. The goal of an outsourcing investment should be achieving a specific business result -- not simply buying cheaper labor. Project risks and execution should be shared responsibilities between you and your outsourcing partner. If you structure the outsourcing partnership correctly, risk reduction happens automatically -- thereby reducing your costs.

2) Methodology matters. Demand that the specific methodology of outsourcing and project execution is an explicit part of your vendor's business proposition. Project governance should be the responsibility of the vendor. Make sure that methodology and governance address the risks of project execution, as well as unique risks of distributed development.

3) Success is a joint responsibility. Success is a function of the time and effort invested into the project by the stakeholders (engineering, IT and business users). The absolute key to success is frequent and timely feedback by the all the stakeholders, particularly on the business side. Whenever possible, clearly identify the decision-making criteria in advance so that the team can work most effectively to meet your business goals.

4) Things will change. Within any project, change is inevitable. Make sure the business model and the methodology are nimble enough to absorb business change, and that the sign-off approving project change is held in the relevant hands. To ensure maximum project return, reassess and reconfirm priorities periodically during the project as part of the project execution methodology.

5) Align end to end. Because outsourced projects rely on resources who are working for a different company, there is the potential for staff changes to affect your intellectual property and project control. The best way to minimize this risk is to make sure your outsourcing business model aligns you and your outsourcing vendor all the way from overall business goals down to the staff level. Specifically, verify that the HR and compensation strategy of the vendor aligns with your project goals.

The health care technology industry has already asked IT departments to do more with less, reduce staff and stretch existing legacy systems far beyond their original life expectancy. Under the normal circumstances of a down economy this is a risk organizations are forced to take. The mandated EMR system implementation compounds this situation and will push outsourcing practices to change.

President Obama's economic recovery package allows for billions of dollars for health care IT investment. As the recovery package begins to be distributed, hospitals and health care providers have significant monetary incentives to demonstrate "meaningful use of certified electronic health record (EHR) technology."

The benefits of EHR systems are numerous. However, for those organizations that want to maximize the amount of stimulus funds received, the time to begin the transition is now, as EHR implementation is a long and challenging road.

In order to encourage hospitals to make an early switch to EHRs, the millions offered in incentive payments will incrementally decrease the longer a hospital waits to adopt the electronic system. Hospitals that implement the EHR system within the first three payout years (2011 - 2013) will receive the maximum funds, each year thereafter decreasing by 25 percent until eventually funding disappears.

Hospitals will also be penalized for not making the switch to EHRs with decreased Medicare and Medicaid reimbursement. For example, if an organization is not EHR-equipped, it may only receive 95 percent reimbursement, versus the 100 percent reimbursement that an EHR-equipped hospital might receive.

While there's certainly some resistance among the health care community in implementing EHRs, we must realize that electronic record keeping is certain to become standard given the administration's focus and the direct involvement of heavyweight corporations such as Wal-Mart.

As hospitals and health care providers grapple with rapid advancements in technology, the new breed of doctors that grew up in the Internet age choose to work for institutions that employ the most modern and up-to-date communications and EHR systems. So, another major benefit of EHR technology is its influence on attracting and retaining the best talent.

Beyond all the benefits for hospitals, an EHR system has a real life-saving potential. EHRs allow for not only the rapid transfer of information from physician to pharmacy but also the ability for medical professionals to access records simultaneously, reduce errors and cross check prescriptions for contraindications. Especially during emergency situations, easy access to records can make the difference in life-threatening situations. Soon, EHRs will enable paramedics to access patient records, on-site, in real time, identifying any pre-existing conditions or allergies to medications.

Finally, by avoiding multiple entries, EHRs can increase efficiencies and streamline operations, allowing hospitals to shift focus from heavy clerical tasks to more mission-critical tasks.

EHR implementation, depending on where a specific organization is in the transition process, can take 2-3 years. Therefore, it is critical to take the right steps toward implementation now in order to receive maximum stimulus funds and ensure a smooth and timely transition.

In essence, EHR implementation is a six-step process. The first step is an initial assessment of a hospital's existing infrastructure and data to determine its quantity, quality and age. Patient records must be up-to-date and consistent throughout the hospital prior to the transition to ensure a flawless switch. 

Once the infrastructure has been assessed, the future state of the hospital must be defined to answer the question: Which best practices need to be implemented for this particular hospital system?

A gap analysis will then define what will need to be upgraded or reformatted to interface each system into the future state, followed by the development of an overarching strategy to close the gap.

Once a strategic plan is in place, the next step is to build a business case that includes the cost of the implementation, time needed for completion, long-term payback and any other advantages or disadvantages to be realized through the implementation.

Lastly, the longest and most challenging step is the implementation, which will involve implementing both the technical specifications of the envisioned system as well as the business process to enable the desired shift. This stage includes vendor analysis, hardware and software implementation, and building custom software for the institution. All the appropriate business processes need to be in place in order to convert to a new EHR system.

Normally, hospital IT departments are not staffed to implement new, large initiatives such as EHR systems. They are staffed to address the critical day-to-day issues necessary to keep the hospital running, so a smart way to expedite the implementation is to use an outside party to oversee and manage the process. This will allow for an uninterrupted process of assessment and plan development for the hospital, without any internal distractions. This is a relatively small expense for a dedicated team that is unbiased and unburdened by constituencies or existing projects, either of which can delay getting an EHR system up and running.

With the first stimulus payouts beginning in 2011, putting EHR implementation on the back burner will only hurt an institution. Delaying lets the competition race ahead and diminishes the financial incentive. Start today. It makes financial sense, and more importantly, helps patients.

A large majority of readers -- 65 percent -- who answered ADVANCE's online opinion poll during the past month said they need to rework their existing EHR plans in light of the HIT provisions of the recently enacted American Recovery and Reinvestment Act.

Twenty-two (22) percent of respondents said they need to expedite their current EHR plans.

Six (6) percent said they are already making meaningful use of a certified EHR.

Four (4) percent said they need to study the legislation in more detail.

Four (4) percent said they are starting from scratch with their EHR plans.

A total of 79 readers participated in the poll.

Click here to participate in this month's poll, which asks you to estimate the probability that the Obama administration will be able to achieve universal health care coverage as part of its health care reform plan.

It's official. The economic recovery package has been signed and $19 billion is marked for health information technology. But, before we can fix anything or facilitate technology adoption, we need to understand the major shifts and changes that are occurring in health care today.

Since President Bush's call to action in 2004, the government has made some progress with electronic health records and regional health information exchanges. These are good first steps, but advances in technology and changing values in our society mean our industry must become more agile to accomplish the radical transformation the industry needs to undergo. The rapid increase in consumer uses of Web 2.0 for health care information and community-building has changed the nature of the doctor-patient relationship and the way health care is consumed today. At the same time, the increasing amounts, depths and accessibility of medical knowledge have necessitated a change in thinking about the way medicine is taught and will be delivered in the future.

From a consumer perspective, the Internet has democratized health care. Access to vast quantities of vetted, actionable and reliable health care information has shifted the "power of knowledge" from the doctor to the patient. In earlier generations, only doctors had the latest medical information or experience managing disease. Now, people are constantly "plugged-in" and can easily search online for health care information. They also can access social networks of people with similar ailments with whom they can share their collective wisdom. This has irrevocably changed the nature of a doctor's relationship with patients. As part of health care reform, the new Secretary of Health and Human Services will need to think about how we can change the structure and policies of health care to acknowledge this and monetize the automated, online or virtual service models that consumers are demanding. 

Furthermore, unlike past generations, today's patients have become more empowered and active in managing their own wellness. Web-focused, techno-savvy health care consumers are more willing to store personal or private information online in the hope of speeding progress for cures. Many now create and manage their own personal health records online. Hopefully, the new Secretary will work with President Obama to help cultivate this consumer grassroots movement to personal health records with the right incentives, standards and economic policies.

From a medical perspective, the recent completion of the Human Genome project will enable a new frontier in personalized medicine. The study of genomics has progressed to the point where experts can not only identify more than 20,000 individual genes in a human's DNA, but also how they relate to drug treatment. This advanced medical knowledge, combined with improved information access, will enable preventative and diagnostic care to match unique personal genetic characteristics. The impact of this is that future drugs will be tailored to an individual's genetic composition and history, making them more effective in treating diseases in each individual. However, before we achieve this goal, personalized health care will require many factors -- both diagnostically and therapeutically -- to be managed in a completely different way from the past.

With these trends in mind, I hope the new administration understands people are increasingly thinking of health care as a consumer service. Today's patients comparison shop and have become "prosumers." They not only choose their own care, but also produce vital information in the process. As a result of this health care consumerism and the rise of the Web, doctors will act more and more like consultants as the main mode of doctor/patient communication transitions to the Internet instead of a visit to the doctor's office. Thus, virtual management of patient conditions will become increasingly common. I hope the administration keeps these trends in mind and works toward enabling a future in which personalized healthcare and mass customization of treatments becomes a reality.

I am hopeful the administration will approach health care reform with an open mind, listening to alternative views, embracing current realities and facilitating positive change. If so, we will all benefit from a new frontier in health care in 2009 and beyond.

Guest commentary by David St. Clair, founder and CEO, MEDecision

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they'll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren't far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN's Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone's Social Security number and date of birth.

While this assessment may be accurate, it's a bit light on the fairness scale. Brown and Cohen only make brief mention of facts like President Obama's plan to appoint a chief privacy officer and to implement unprecedented privacy controls to safeguard the EHR transformation. Instead they emphasize the more sensational angle implying that electronic health information just isn't safe. They also seem to downplay the fact that a simple thing like creating a password can protect one's private information.

I suspect the privacy issue is going to reach a crescendo in the coming months, and it's very important that Americans have all of the facts. There are unfortunately people in the world who are going to try to illegally obtain and misuse private health information. But that doesn't mean we should just write off EHRs as a bad idea. We simply need to be vigilant and proactive in incorporating the highest security measures into the planning process -- which the president has done. To borrow an analogy from a close colleague: We don't stop building roads because some people drive drunk. We punish the drunk drivers and continue building roads because of the tremendous benefits they bring to the rest of our law-abiding society. There is too much at stake for the health care system and the nation's economy to allow over-dramatized and misperceived weaknesses in EHR security to thwart progress.

Additionally, to make the privacy debate a fair one, we must ask what's more dangerous: the potential misuse of information or simply not using information at all? Should we put the privacy of an overwhelming minority of people ahead of safer, more efficient, more affordable and potentially life-saving health care for the overwhelming majority? In reality, the only people who stand to be harmed by an unlikely EHR privacy breach are celebrities and other high-profile individuals. Even if someone were to gain access to the average person's health information, there isn't much they could do with it, other than cause that person some personal embarrassment. In a very real sense, the question then becomes whether we value the privacy of information more than its potential to help us lead healthier lives.

Without question we must make ensuring privacy a top priority in any plans to implement EHRs. I'm confident that the Obama plan does so and, in fact, I think we'll see even stronger controls than we may have previously imagined. No EHR is going to come with guaranteed safety, but I would argue that the risk level is the same or less than that associated with online retail and banking transactions. The public needs to understand this. It is up to those of us in the industry to ensure that the facts are clear and readily available. Hopefully the media will choose to report all of them so that Americans can form opinions based on complete information.

Guest commentary by Wayne Janzen, Executive Information Agenda Consultant for Global Government and Health Care, IBM

Health care organizations have made significant investments in IT over the years to improve both patient care and business processes. For genomic research, predictive medicine, and even basic preventative care, more information is available now than ever before. However, the need for more intelligent health care remains at a tipping point. The push toward higher standards in health care will only continue given The American Recovery and Reinvestment Act, which includes a $19 billion allocation toward health information technology, was passed by Congress and signed into law by President Obama this week. In an age when we cannot afford not to have health care reform, intelligent information lays the foundation for a new approach to transforming the delivery of health care and contributes to a new infrastructure for the health economy.

Despite large investments in areas such as electronic medical records, diagnostic imaging, practice management and scheduling systems, many health care organizations remain data-rich and information-poor due to the volume and complexity of data they have to deal with. Medical mistakes kill nearly 100,000 people every year, according to the Institute of Medicine. "That is equivalent to a 747 crashing every other day," according to Denis Cortese, MD, president and CEO of the Mayo Clinic. These errors, more than half of them preventable, cost the United States as much as $29 billion each year.

While most health information systems are designed to provide data quickly -- one patient at a time -- most are not designed for the cross-patient analysis required to answer complex questions. Meanwhile, critical opportunities for collaboration and interoperable information-sharing are often missed. In health care, on-demand access to pertinent and complete information about patients is mission critical.

Are you getting the most out of your data ?

One of the greatest challenges to our health care system today is that valuable data remains in disparate systems built for speed and performance, not aggregation and analysis. Reporting, analyzing and trending quality and cost data can provide valuable information to improve medical outcomes, but the reality is this is labor-intensive. Frequently, too much time is spent gathering and accessing data instead of analyzing information. Many providers spend millions of dollars acquiring and implementing advanced information systems that collect incredible amounts of data. According to the 2008 Healthcare Information and Management Systems Society (HIMSS) Leadership Survey, 44 percent of organizations have a fully operational electronic medical records system in place at one or more of their facilities. More complex functionality, such as computerized physician order entry, physician notes or clinical documentation, is slowly being implemented and adopted. However, health care organizations often find themselves stymied when asked to prove how these new systems have affected outcomes and improved overall care and efficiency.

Implementing new systems and collecting more data is just one piece of the puzzle in the effort to achieve the new administration's goals for dramatically improving health care delivery for every American. Vast amounts of data and content must be tapped so health care organizations can better focus on their primary mission -- delivering top-quality patient care in spite of intense pressure to cover rapidly rising costs, and maintain profitability through improvements in operational efficiency.

In light of significant reforms in health care policy and new investments in health information technology, the challenge becomes to create a comprehensive, holistic view of data spread among multiple applications from myriad vendors. Data from those applications must be synchronized through careful planning and organization around a well-defined architecture supported by a robust information infrastructure. To accomplish this, health care organizations need to achieve information agility, where they are able to leverage trusted information as a strategic asset. Those with a strategy for effectively using information have an opportunity to outperform their competitors and innovate quickly while maintaining high levels of patient care. Some of the most successful health care organizations are developing an Information Agenda to do just that.

An Information Agenda is an approach for transforming information into a trusted source that can be leveraged across applications, processes and decisions. It allows organizations to achieve information agility by accelerating the pace at which information can be managed independent of applications or business processes.

An effective Information Agenda can help health care organizations:

● improve quality of care;

● create a safer patient environment;

● increase revenue and gain entry into new markets;

● reduce costs and enhance operational efficiency;

● introduce new services quickly;

● improve clinician productivity and efficiency;

● meet regulatory requirements and reduce risk exposure;

● increase compliance visibility; and

● protect patient and financial data and mitigate fraud risks.

Four key components of an Information Agenda are imperative for addressing the information needs of health care business processes.

Information strategy - In creating an information strategy, you must take into account the primary information-centric clinical and business imperatives that drive virtually every decision. These include areas such as cost reduction and improved efficiency; profitable growth; quality; safety; governance and risk. A vision for managing each of these areas can help guide decisions and determine how best to support business goals.

Information infrastructure - A unified information infrastructure enables the effective creation, capture, management and use of information associated with patients, services, products and market. By deploying an information infrastructure that meets both immediate and future needs, health care organizations can begin the journey of using information in new ways to enable smarter health care.

Information governance - Information governance establishes standards for data quality, management processes and accountability. These standards help improve business performance through the creation of standard definitions and processes that establish a more disciplined approach to managing data and information across the enterprise.

Roadmap - An Information Agenda roadmap provides the direction to help unlock the value of information for not only improved care, but the delivery of trusted, accurate information to optimize clinical and financial performance. The first step in creating a step-by-step plan is to identify and prioritize IT projects that have the greatest impact in helping health care organizations achieve their strategic imperatives

Consistently delivering trusted information, securely, to the right people at the right time, provides the ability to use information in entirely new ways to improve care delivery and operational performance. New technology allows data capture from a host of medical devices, images and laboratory diagnostics almost anywhere. In recent years, the cost of storing and managing that data has come down dramatically, and the ability to apply sophisticated analytical tools has improved clinical outcomes along with the ability to ensure patient privacy. As high-bandwidth communications and high-performance computing continues to evolve, trusted and secure information for smarter health care will become more critical.

The volume, variety and velocity of data in health care is a very good example of where our world needs "new intelligence." With information at the center, it will be easier to manage and process medical records to lower the cost and increase the quality of health care, put more research and genetic data to work, and shift from a system that treats disease to one that better prevents and manages it.  

With the passage of the Obama economic stimulus package by the House of Representatives, now in Senate review, there has been a lot of discussion about what the $20 billion slated for health care IT will mean for the industry. The plan places heavy emphasis on electronic health records (EHRs) as a way to lower costs and improve care. While this is an important first step, the administration needs to be thinking about what comes after EHRs and include payers in the provider-patient equation.

The stimulus plan proposes the creation of a nationwide health information network built on an interoperable technology architecture that supports electronic exchange and use of health information. It promises that every person in the United States will have an electronic health record by 2014. There is a tremendous opportunity to extend these efforts to enable transparency of cost and quality information.

American consumers have come to expect the availability of vast amounts of Web-based information thanks to the technology investment made by dozens of other industries. Only in health care do consumers consent to pay for services without access to cost and quality information. Numerous studies have shown that the fees for medical procedures and services can vary greatly even in the same geographic region. Controlling the cost of health care requires that consumers have access to the same level of information that they get from other industries.

The health information network should be built with a framework that supports extending transparency beyond health records to enable providers, patients and payers to exchange cost and quality information and facilitate collaboration between these stakeholders. Consideration needs to be given now to the technology tools needed to make cost and quality information available to consumers. Waiting until later will increase the cost and burden of implementation and negatively impact consumer adoption. We've seen historically low EMR and Health Information Exchange adoption rates. It makes sense to leverage the efforts of the government to make health information available and extend that push to cost and quality transparency. 

Driving down the cost of health care and improving care has to include accessibility to what providers charge and how well they deliver care as a critical component to decision-making. Without access to this information, we run the risk of having suboptimal cost savings after a large investment in technology platforms that do not support informed decision-making on the part of those consuming health care services.

Keep your fingers crossed on health care reform, because a report out today, says that (some) funding in President Obama’s stimulus package might actually be in jeopardy:

“Senate Democrats have vowed to strip those measures from the bill. But now moderate senators, including some Democrats, uneasy with the size of the package are considering trimming one of Obama’s top priorities: providing seed money for doctors and hospitals to begin computerizing patient records, a first step in broader reforms he plans to offer on health care,” a report by Jeanne Cummings at Politico said.

Guest commentary from Mark W. Stevens, Executive Director of the Pennsylvania eHealth Initiative and Advocacy Co-Chair of the Delaware Valley chapter of HIMSS

A Dad Takes His Daughter to D.C. to Witness History

On Tuesday, January 20^th at 3:45 a.m., we boarded a chartered bus from West Chester, Pa., to Washington, D.C.

 My 12 year-old daughter, Morgan, is a big Obama fan (as is the rest of her family for that matter), so I had purchased bus tickets to the Inauguration as a Christmas present as soon as they became available from our county Democratic committee.  When we arrived in Washington, it was 7 a.m., 20F degrees and windy.  I had lived in D.C. for two years after college, working as a doorkeeper (i.e., tour guide) in the Senate and as a gofer at a lobbying firm, and had never experienced that kind of cold there  before, all the while thinking that we were going to be outside until at least 5 p.m.

As a parent, I've learned firsthand the truth of the adage "90 percent of life is showing up", and have tried to be there for my girls' "big moments," but I didn't expect tears to well up when I got to the Mall (I said it was due to the wind).  The crowds, the monuments, the beauty and awe of the moment were overwhelming.  There were entire families camped out in the cold.  Goodwill and joy were evident everywhere (I learned later that there was not one recorded arrest connected to the Inauguration festivities - this with an estimated crowd of 1.8 million), as was the sense of history being made... 

We watched the ceremony on a jumbo-tron TV at the front of the Smithsonian.  People around us sang, cheered and waved flags (over 1 million were handed out free of charge).   For "W," many booed...

We did a lot of people-watching, and took some fun pictures (before the camera died - my daughter had remembered to charge her cellphone, though!)  I was thinking about the health care IT stimulus package, and would it make the difference we all hoped for, when we bumped into Chris Matthews (host of MSNBC's "Hardball"), who popped out of a media trailer we happened to walked by.  My daughter remarked that she had no idea she would see "celebrities" at the Inauguration (I told her there were probably more movie stars in Washington, D.C., that day than were in all of Hollywood).  Following the swearing-in ceremony, we made the long, circuitous trek back to the parade route along Pennsylvania Avenue (walking past many of the 5,000 portapotties in town for the day - apparently the largest such assemblage ever). Against all odds, we wanted to get a glimpse of the new President and First Lady, and were just able to see their limo when a nice couple approached us and gave us their VIP-access tickets so that we could get a more close-up look, and remarking how nice it was to see a Dad and his daughter together. 

I couldn't have agreed more.

Photo credit: Morgan Stevens

CTIA also suggested that attendees who are meeting up with others should be sure to have a back-up plan in case cell networks experience disruption, the CNET report said.

The Washington Post reported that a Jan. 18 concert at the Lincoln Memorial provided a good test for the wireless networks. The article said an estimated 400,000 concert-goers "sent 10 times the volume of wireless calls, text messages, pictures and videos as on the busiest hour of a typical day."

"The vast majority of calls went through on the first try," Verizon Wireless spokesman John Johnson told the Post. "We'll be making every adjustment we can make. I don't believe there's any critical capacity we can add, but [Sunday] did help us to do some fine-tuning."

"We did experience some mild call-blocking, as was expected, but with the capacity we added and the number of calls we got on the network and the amount of activity, our network worked about as well as we expected," Crystal Davis, a spokeswoman for Sprint Nextel, told the Post.

Guest commentary from Cheryl McEvoy, editorial assistant for ADVANCE for Health Information Professionals.

Obama's transition team has extended an open invitation to all Americans to participate in community discussions about health care reform over the next 2 weeks. It's a chance for the average citizen to air grievances and offer solutions to improve the health system, which -- if all goes as planned -- will be reported back to the President-elect.

But it looks like health care stakeholders are all too eager to get in on ground-level reform. According to reports, insurance plans, drug companies and medical associations are urging doctors, representatives and patients to attend community meetings. Some are reportedly hosting discussions, which has raised concern that the voice of the people will quickly be drowned out by soapbox dribblings and padded patient testimonials by those who already have a hand in the health care cookie jar.

In the spirit of diplomacy, or to avoid giving a public kiss-off to industry bigwigs, Obama's transition team is welcoming stakeholder attendance at meetings -- occupations aside. They are community members and health care consumers, after all. If meetings are conducted as intended, there should be no problem; informed and inquisitive attendees will generate lively discussion about the current state of health care and how to get it on track to improvement. In fact, the open forums may benefit from the inside knowledge stakeholders have of the industry -- the average citizen may even leave with a better understanding of why America's health care system is so darn hard to fix.

The problem, however, is that any stakeholders who attend the meetings need not identify their healthcare-related affiliations. So that dude arguing against lower pharmaceutical costs may be a rep from Pfizer, and while you value his opinion as a concerned neighbor, his view may be skewed by employee allegiance -- unbeknownst to you, of course. I consider it a "wolf wearing a sheepskin" situation; if stakeholders want in on the discussion, no problem -- just don't pretend to be an ordinary member of the flock. If community members want to be clueless, they can pull the wool over their own eyes.

According to a report released last week by the bipartisan National Conference of State Legislatures (NCSL), lawmakers around the country introduced more than 370 bills relating to health information technology (HIT) during an 18-month period between 2007 and 2008.

The report noted that 132 bills containing HIT provisions were enacted in 44 states and the District of Columbia during the 2007-08 period studied by NCSL. That was a three-fold increased in bills enacted compared to the same period from 2005 to 2006, NCSL researchers said.

The only states that did not enact bills with HIT provisions during the 2007-08 period were Arkansas, Kentucky, Mississippi, Nebraska, South Dakota and Wyoming, according to the report.

The majority of the bills relate to financing and planning efforts, NCSL noted.

Six states enacted comprehensive measures aimed at protecting patient privacy while facilitating the exchange of health data:

• Indiana SB 511 (enacted 5/2/07)
• Massachusetts SB 2863 (enacted 8/10/08)
• Minnesota HB 1078 (enacted 5/25/07)
• Rhode Island HB 7409 (enacted 7/10/08)
• Texas HB 1066 (enacted 6/15/07)
• Vermont HB 229 (enacted 6/5/07)

Click here to access the entire report.