Health information technology: The government moves toward a national mandate

The health care industry increasingly turns to technology for solutions to the many problems associated with inefficient systems. Technology in the ambulatory setting has the potential to improve care in a number of ways:

* Fewer medical errors;

* Increased use of clinical guidelines and evidence-based clinical decisions;

* Improved access to care and quality of care;

* Increased physician productivity;

* Improved coordination of care; and

* Greater patient involvement in health care.

In addition, many in the industry anticipate that extensive use of e-health will reduce costs. But significant barriers remain before group practices and other health care organizations can begin to reap the benefits of this new technology.

On April 27, President Bush signed an executive order establishing a new subcabinet-level position - the national health information technology (HIT) coordinator - and called for most Americans to have a computerized health record within 10 years. By the president's invitation, key health care leaders attended a national summit in May to discuss how best to proceed with HIT implementation. MGMA President and CEO William Jessee, MD, FACMPE, represented group practices at this important event. During the summit, Health and Human Services (HHS) Secretary Tommy Thompson introduced David Brailer, MD, PhD, as the HIT coordinator and facilitated a discussion among national health care leaders regarding existing barriers and potential solutions.

National health information infrastructure

The government's major HIT initiative is the implementation of the National Health Information Infrastructure (NHII). The NHII vision is a comprehensive, knowledge-based network of interoperable systems capable of providing critical health information for sound clinical decision-making. The government will achieve this by adopting critical standards and developing local health information exchanges.

This transformation of the health care system will include enhanced communications networks, message and content standards, computer applications and confidentiality protections. NHII features include:

* Complete patient medical history available at the point of care via electronic health records;

* Electronically available lab results and X-rays;

* Decision-support options for practitioners, including access to the latest protocols, guidelines and research results;

* Quality and payment information derived from the care record, not from separate reporting systems;

* E-prescribing protocols for the provider to the pharmacy;

* Rapid linkage between point of care and public health authorities; and

* Electronic access for patients to their own medical information.

The need for e-heaith standards

The health care industry must rapidly adopt key format, data content and transmission standards to further the acceleration of HIT. Areas that require standardization include:

* Electronic prescribing - As part of the Medicare Modernization Act of 2003, HHS must develop standards by April 1, 2008, allowing prescriptions to go electronically from the physician to the pharmacy. This will permit pharmacists to quickly check on medication availability and health insurance eligibility. It will reduce the incidence of serious medical errors by eliminating illegible handwritten prescriptions and by allowing physicians and pharmacists access to automatic allergy and drug interaction screening. In addition, systems may have the capability to interact directly with a practice's electronic medical records (EMR) system and generate automatic approval from the health plan.

* Electronic medical records - Physicians continue to use paper patient records. This scatters vital clinical information, contributing to inefficiencies and potential medical errors. The health care industry needs standards for the reading, storage and transmission of medical records to improve interoperability and reduce the costs of EMR systems.

* Electronic X-rays - The technology exists to send X-rays electronically from a testing facility to a group practice. Standards need to be developed that will permit interoperability among computer systems and promote their widespread use. Telehealth technology is especially critical to health facilities located in rural areas.

* Electronic laboratory results -Laboratories can send patients' test results electronically to the physician, permitting immediate analysis, diagnosis and treatment decisions. Optimally, electronic laboratory results get automatically entered into the patients' electronic medical records. Once in place, this system would allow a physician to retrieve lab results for a hospitalized patient from the office, ensuring a quicker response to test results, reducing the potential for error and eliminating duplicate testing.

Safe harbors

Legal barriers to the adoption of HIT solutions in medical groups must also be addressed. Antikickback and self-referral concerns prevent some health care organizations from offering free or discounted technology. MGMA has advocated that the government provide legal protections, such as safe harbors and regulatory exceptions, to facilitate HIT implementation. The Centers for Medicare & Medicaid Services (CMS) recently took an important step by creating a HIT safe harbor in the physician self-referral phase II interim final rule.