Update from Washington

Many people have asked me to comment about the latest Washington plans for healthcare IT.

The best and brightest on the Obama transition team, the House Committee on Science and Technology, and the Senate HELP Committee have been talking to academic, industry and government healthcare IT experts.

I believe the message from experts is consistent. The dollars allocated need to fund education, training, and implementation of interoperable CCHIT certified EHRs. What do I mean by interoperable? For 2009 it means result reporting, e-prescribing, and clinical summary exchange. For 2010 it means quality measures, population health, and personal health record exchange. For 2011 it means clinical research/trials support. Here is a document describing the the current CCHIT certification requirements written by Mark Leavitt and containing my thoughts on the interoperability that is available now.

Many in the press and in Washington have just read the pre-publication of "Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions" by William W. Stead and Herbert S. Lin, editors from the Committee on Engaging the Computer Science Research Community in Health Care Informatics of the Computer Science and Telecommunications Board, National Research Council of the National Academies. Some believe that the report concludes we should not invest in healthcare IT now.

What does the editor believe? In an email yesterday to the American College of Medical Informatics, Bill wrote:

"We do not need to wait for better IT before we move aggressively forward. However, near term success will require a fresh approach to managing the investment by health care organizations, our health care IT vendors and the government."

Here's my interpretation of the report and Bill's comments:

The National Academy does not call for a halt in health IT investment, rather for a balanced mix of investments that supports 'incremental progress' with real IT systems today, combined with long-term research that can revolutionize the medical decision-making process. The Academy suggests near-term use of clinical information systems that enable doctors to move toward higher-quality, data-driven medical decisions. Along with that, they recommend long-term research that will provide doctors with the tools necessary to support treatment decisions that draw on large amounts of data both from the individual patient they are treating and relevant research and treatment data from a broad range of research and clinical data.

Investments should pay for the improvement in outcomes resulting from the use of healthcare IT.

To my knowledge, the Obama Administration Economic Recovery proposal for HIT spending will support investment in electronic medical record systems for doctors with funds disbursed as Medicare incentive payments. It doesn't just pay for IT, it pays for quality-of-care outcomes facilitated by IT.

The Academy worries that if we fund large-scale deployment of electronic medical record systems for all doctors, we will implement systems that lack the most advanced features yet to be developed through the research they propose. However, Bill's letter to the informatics community suggests deploying now and my experience is that systems evolve incrementally as clinical workflow changes and new technologies become available. In Massachusetts, I have installed eClinicalWorks version 8.033 for my community-based physicians. It has all the decision support features and interoperability the report suggests, so I know the vendor community can deliver what it is needed.

What else am I hearing in Washington?

*The entire stimulus package is expected to cost between $700 billion - $1 trillion. Reportedly, Obama now wants to include up to $300 billion in tax cuts, primarily aimed at individuals and small businesses, in part to gain Republican support. The timing of the completed package seems to be targeted to late February.

*The dollars to be allocated to healthcare IT range from $5-$25 billion.

*In my conversation with Senators, the dollars allocated will not just fund hardware and software. They will include funding for quality measurement, evaluation, training, education, privacy/security, interoperability, and incentives to use the technology to improve care. There is not consensus between the Senate and House of Representatives on the final approach, but hearings are likely to begin soon.

I will watch the unfolding events and relay my interpretation of what is happening in the transition teams and Congress. If you are asked to testify, I hope you offer similar advice to my own:

The products available in the market today are good enough and continue to evolve to include more decision support and interoperability per the CCHIT roadmap.

The standards for labs, medications, and clinical summary exchange harmonized by HITSP are recognized by the US government and are good enough.

Now is the time to invest. We're at the tipping point. Wise investment, with accountability for use of EHRs and incentives to achieve coordinated quality care, is needed to transform healthcare in the US.