Friday, January 27, 2012

The Role of Health IT in Transforming Healthcare

The Bipartisan Policy Center's (BPC) Task Force on Delivery System Reform and Health IT released a very timely set of recommendations for the most effective use of health IT dollars to support coordinated, accountable, patient-centered health care. The full report is available HERE. There was a webcast discussing the release of the report. Senators Tom Daschle and Bill Frist, Co-Leaders of BPC’s Health Project, and Governor Ted Strickland made remarks at the event. BPC Health IT Task Force members, including John Engler, President of the Business Roundtable, and Karen Ignagni, President and Chief Executive Officer of America's Health Insurance Plans, also provided insights on the findings and recommendations in the report.

The report recognizes that there remain several gaps in and barriers to achieving the health IT capabilities needed to support these common attributes of high performance and new models of care:
  1.  Misaligned Incentives New models of care, supported by the health IT capabilities required for their success, will not become the norm without transforming the nation’s primarily volume-based payment model to one that promotes higher quality, more cost-effective care.
  2. Lack of Health Information Exchange While the exchange of information across the multiple settings where care and services are delivered is a central and necessary component of coordinated, accountable and patient-centered models of care, the level of health information exchange in the U.S. is extremely low.
  3. Limited Level of Consumer Engagement Using Electronic Tools Health IT plays a critical role in supporting patient centered care, yet use of electronic tools to coordinate care, drive provider-patient communication, and empower patients to manage their health and health care is not widespread.
  4. Limited Levels of EHR Adoption While EHRs are a necessary foundational component for new models of care, the level of EHR adoption and Meaningful Use among physicians, hospitals and other provider organizations remains low.
  5. Privacy and Security Concerns Consumers expect that their health information will be kept private and secure. Solidifying public trust in health IT and electronic health information exchange initiatives will require assurance about the processes used to protect the privacy and security of health information.
  6. Multiple Federal Priorities Require Focus and Attention Health care organizations are faced with numerous requirements associated not only with health IT, but also with delivery system and payment reforms, health care coverage and access challenges, administrative improvements, and program integrity brought about by the Patient Protection and Affordable Care Act (ACA) of 2010, HITECH and other federal, state and private sector programs.
But just as importantly the report lays out solutions that could be implemented in a bipartisan way to address these gaps. The full report goes into great detail on how to address each the key issues raised. One important recommendation regarding EHR adoption is to improve the usability and safety of EHRs and accelerate the maturation of the EHR market. They propose that vendors, clinicians, hospitals and other providers should collaborate to identify common challenges and issues related to usability, including those with implications for patient safety, and develop and execute strategies to overcome them. I believe that usability should be a component of the standards and certification criteria for future stages of meaningful use.

They also make some suggestions to increase engagement of consumers using technology tools. They urge that the consumer awareness campaign initiated by ONC be built upon, and that both the public and private sectors should take additional steps to demonstrate how electronic tools can help consumers manage their health and engage further with their providers. This should be an encouragement to Lygeia Ricciardi, the ONC's Consumerista.

They also make detailed recommendations on how to build a business case for health information exchange. Aside from encouraging expansion of requirements for meaningful use they also recommend that Federal, state and private sector purchasers and payers should require that data standards adopted by the secretary be reflected in the specifications associated with clinical quality measures required by their payment or incentive programs. Health information exchange is a critical component of any strategy to use health IT to improve care and lower costs. I know that policy makers are taking these recommendations into serious consideration. I strongly recommend anyone interested in using technology to improve health care read this report. 


  1. Thanks, Brian. It's a thoughtful and helpful report, and I appreciate your summary and commentary on it. We at ONC will seriously consider its recommendations (I've already sent links to several colleagues). And indeed I do feel encouraged to keep going with our consumer engagement work in collaboration with our many partners (thanks!).

  2. Great writeup. The outcome-based approach is the only one that makes sense. To get to outcome-based healthcare, there has to be a way for data to be 'in motion' versus silo'd inside multiple vendor systems. That is a big hurdle to clear as many vendors are busy selling providers their silo'd systems designed to gain incentive money. For every one system that is really EMR, there are one hundred others that don't talk to the EMR. ICD-9/10 is looming large and CORE after that. It will be very interesting to see how this all works out over the next two to three years.