A REPORTER'S TOOLKIT: HEALTH INFORMATION TECHNOLOGY

An Alliance for Health Reform Toolkit -
Produced with support from the Robert Wood Johnson Foundation

This toolkit was compiled and written by Sam Takvorian.

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Place your cursor over underlined terms to see definitions. You can also click on underlined terms to see definitions in the glossary at the end.

Key Facts

  • Health information technology (IT) encompasses a broad array of technologies involved in managing and sharing patient information electronically, rather than through paper records.
  • Health IT has the potential to improve patient safety, health care quality, efficiency and data collection and may help restrain rising costs.
  • Adoption of health IT has generally been slow in the U.S. For example, while one in four doctors reports using electronic health records (EHRs), fewer than one in ten is using a "fully operational" system. 1
  • Computerized physician order entry (CPOE) - a component of fully functional EHR systems that may help reduce preventable medication errors by half or more. 2 Few hospitals have fully implemented CPOE systems. 3
  • An important challenge for health IT is its cost: who should pay? Providers are expected to bear most of the cost of implementation, while much of the savings accrue to others - insurers, patients and governments.
  • Another challenge is protecting patient privacy. Once confidential patient information has been stored electronically, only those with a legitimate need to know should have access to it.

Background

Many in the U.S. have high hopes for health information technology, or health IT. Hospitals hope to reduce medical errors, such as ordering and administering the wrong dose of a medication. Providers hope to access and share patient information more easily, thereby improving care. Governments and businesses hope to save money by improving efficiency. According to RAND Corporation researchers, full implementation of health IT systems could produce efficiency savings as great as $77 billion per year after a 15-year adoption period. 4

But for a variety of reasons, health care providers have not fully embraced these technologies. Some experts note that high implementation costs deter providers, especially those in small group practices, from adopting new technologies. 5 Other studies suggest that implementing health IT systems might even hinder patient care, at least initially. 6 In either case, the question remains: how should policymakers help facilitate the adoption of health IT?

Health IT encompasses a broad array of new technologies designed to manage and share health-related information. The most basic type of health information technology is a system that electronically collects, stores and organizes health information about patients. When properly implemented, such a system can help coordinate patient care, reduce medical errors and improve administrative efficiency. 7

Some call the information collected an electronic health record (EHR); others call it an electronic medical record (EMR). Though some health informatics experts make a distinction between EHRs and EMRs, 8 these terms are often used interchangeably in the media. Efforts are underway to develop consensus definitions for these terms and others. 9 For convenience, we will use the term "electronic health record," or "EHR" to refer broadly to systems that collect and store patients' medical information in digital form. An EHR differs from a personal health record (PHR), which is a health record that is "owned" and maintained by an individual patient, rather than by payers or providers.

Electronic record systems come in a variety of shapes and sizes. Some collect and share patient information only within a certain institution or within a certain provider group, while others are integrated into larger information networks. The capabilities of EHR systems and the extent to which they are integrated into provider practices also vary. "Fully functional" EHR systems collect and store patient data, supply patient data to providers on request, permit physicians to enter patient care orders, and assist providers in making evidence-based clinical decisions. 10

Another technology is known as computerized physician order entry (CPOE), an important part of a fully functional EHR system. This allows physicians to order prescription drugs and laboratory tests digitally, thereby eliminating errors associated with illegible hand-written prescriptions. CPOE systems check for the accuracy of prescription orders, flagging any orders that appear extreme. One study concluded that CPOE systems for prescriptions could reduce preventable medication errors by as much as 55 percent because they ensure, at a minimum, that orders are complete and legible. 11

Despite this potential, adoption of health information technology has been slow. Much clinical information in the U.S. remains on paper rather than on computers. Recent studies have shown that only about 10 percent of hospitals and providers have fully implemented EHR systems 12 and even fewer have adopted CPOE systems. 13

At the national level, the Office of the National Coordinator of Health Information Technology (ONC) was established to promote health IT and to meet the President Bush's goal of making an electronic medical record available for most Americans by 2014. However, funding for this federal body lags well behind spending for counterpart agencies in other countries. 14 Furthermore, at the time of publication, lawmakers in the Senate were considering legislation that would mandate physicians under Medicare to use e-prescribing systems such as CPOE. 15

In order for health IT to deliver on its promise, several obstacles must be overcome. First, health IT systems must be able to speak the same language; in computer terms, they must be "interoperable." These systems must also be linked in some way. One model of such "connectivity" is a national network structured around regional networks, or health information exchanges (HIEs). 16 HIEs allow for the digital exchange of clinical information across organizations within a region or community. Organizations that run an HIE are known as regional health information organizations (RHIOs).

Beyond technical considerations, there is the issue of cost. Health IT systems often carry hefty price tags. A recent study found that initial EHR costs average nearly $44,000 per full-time provider, plus an additional $8,500 in annual operating costs, for small group practices. 17 Policymakers must decide who should pay for this.

Currently, providers are expected to bear most of the initial costs, while most of the savings accrue to others. For example, hospitals often spend tens of millions of dollars on CPOE systems, providing benefits for other stakeholders-insurers, purchasers and patients. One major study found that it would cost more than $150 billion over five years to develop a nationally interoperable system, including equipping physicians with standardized IT systems. 18

Another issue is whether patient privacy might be jeopardized by health IT systems. Medical records often include personal information such as names, addresses and social security numbers, as well as confidential clinical data. In order for health IT to take hold at the national level, patients must feel assured that their information can be accessed only by those with a legitimate need to know. 19

Though the jury is still out as to whether health IT will deliver widespread improvements in efficiency, cost savings and quality of care, there are several working examples of interoperable health information technologies. The Department of Veterans Affairs greatly improved the quality of care at its facilities with a new health IT system. 20 When Hurricane Katrina struck the Gulf Coast, VA electronic health records were easily salvaged whereas untold numbers of paper records were destroyed. 21 Furthermore, immunization information systems have proven to be cost-effective ways of aggregating and managing public health data. 22 These efforts are reminders of the potential that health IT may hold for reforming the entire health care system.

Selected Resources

Please email info@allhealth.org if you find that any of the links mentioned in this toolkit no longer work.

Overview: Health IT

  • "Information Technology Comes to Medicine"
    David Blumenthal and John Glaser, New England Journal of Medicine Vol. 356: 24, June 2007
    www.allhealth.org/publications/Health_information_technology/
    Information_Technology_Comes_to_Medicine_71.pdf

    This article explains the basics of health information technology, including a description of electronic health records, personal health records, and clinical data exchanges. The authors discuss the changing role of information technology in health care, the barriers to its adoption, and the benefits and risks of health IT. (7 pages)

  • "Navigating American Health Care: How Information Technology Can Foster Health Care Improvement"
    Karen Davenport, Center for American Progress, May 2007
    www.americanprogress.org/issues/2007/05/pdf/health_it.pdf

    In this report, Karen Davenport of the Center for American Progress reviews the promise of health IT and the barriers to its implementation. She then addresses strategies for improving health IT adoption, including a discussion of national interoperability standards and enhanced privacy protection. (24 pages)

  • "Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care"
    Basit Chaudhry and others, Annals of Internal Medicine, Vol. 144: 10, May 2006
    www.annals.org/cgi/reprint/144/10/742.pdf

    In this article, the authors present a review of recent literature assessing the effects of health IT on quality, efficiency, and cost of care. The Appendix summarizes scores of important studies on the impact of health IT, broken into relevant categories. (29 pages)

  • "Essential but Not Sufficient: Information Technology in Long-Term Care as an Enabler of Consumer Independence and Quality Improvement"
    Ross Martin and others, BearingPoint, September 2007
    http://ncqltc.org/pdf/BearingPoint_Report_for_NCQLTC.pdf

    This report examines the role of health information technology in long-term care and makes recommendations on how long-term care can be transformed through the application of health IT. The authors caution that health IT adoption is not an end in itself, but has tremendous potential to enable consumer independence and quality improvement in long-term care. (60 pages)

Electronic Medical Records/Electronic Health Records (EMRs/EHRs)

  • "Performance Improvement Special Report"
    Mark Hagland, Healthcare Informatics, May 2007
    www.healthcare-informatics.com (Click the "Back Issues" button, then click on the May 2007 issue.)

    This three-part cover story addresses many of the current issues at stake with the implementation of electronic health records. Generally, those quoted stress that EHRs have led to significant reductions in medical errors and improvements in quality. Still, some caution that these systems are exceedingly complex and administrators must be careful when integrating them into clinical practices. This issue also includes other articles on the "EMR Revolution."

  • "EMRs don't guarantee quality care, a review of 50,000 patient records shows"
    Kevin B. O'Reilly, American Medical News, August 2007
    Free abstract at: http://archinte.ama-assn.org/cgi/content/short/167/13/1400

    According to the study referenced in this article, physician offices using EHRs don't deliver better quality ambulatory care than those using paper records, on most quality measures examined. Researchers examined more than 50,000 patient records from more than 2,500 physician offices to draw conclusions. The study, published in the Archives of Internal Medicine on July 9, sheds light on how little is known about the quality implications of electronic systems, as they are used in everyday settings.

  • "Continued Progress: Hospital Use of Information Technology"
    American Hospital Association, February 2007
    News release: www.aha.org/aha/press-release/2007/070227-pr-hitreport.html

    This study, sponsored by the American Hospital Association, documents the extent to which hospitals are adopting health IT. Despite the sizeable financial and implementation challenges of health IT adoption, hospitals continued to accelerate their use of health IT in 2006, this study finds, with 68 percent reporting fully or partially implemented EHR systems. Full 24-page study available at www.aha.org/aha/content/2007/pdf/070227-continuedprogress.pdf

  • "Paving the Way for the Second Wave of EHR Adoption"
    Tom Leonard, Health Management Technology, February 2007
    www.healthmgttech.com/features/2007_february/0207paving_way.aspx

    In this article, Tom Leonard discusses gaps in EHR adoption. While as many as 40 percent of large practices (with more than 25 physicians) have fully implemented EHR systems, smaller practices often rely on paper records due to the substantial upfront cost of implementation. Leonard argues that the next wave of EHR adoption should be hospital-based rather than physician-based in order to distribute the costs of implementation more fairly.

  • "Health Information Technology in the United States: The Information Base for Progress"
    Robert Wood Johnson Foundation, October 2006
    News Release: www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10439

    One in four doctors use electronic health records, according to the study described in this news release. However, fewer than one in ten are using a "fully operational" system that collects patient information, displays test results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions. Adoption rates remain very low due to multiple financial, technical and legal barriers. For the full 86-page report, go to: www.rwjf.org/files/publications/other/EHRReport0609.pdf.

  • "KP HealthConnect: The Latest on Kaiser Permanente's Electronic Health Record Project"
    Kaiser Permanente
    www.kphealthconnectq4update.org/index.html

    This site describes in detail Kaiser Permanente's multi-billion-dollar effort to develop electronic health records for all of the plan's members and to "connect 8.6 million people securely to their health care teams." Kaiser Foundation Health Plan Chairman and CEO George Halvorson notes that the system is especially helpful for emergency room patients. Problems with the system are being "aggressively" addressed, the site notes (see resource below).

  • "Kaiser Permanente's Electronic Health Records Project Has Technical Problems"
    Los Angeles Times, February 21, 2007
    Summarized at www.medicalnewstoday.com/articles/63273.php

    The Los Angeles Times reports that Kaiser Permanente's EHR project (see reference above) has experienced "repeated technical problems," such as being less than fully operational at certain Kaiser facilities. The glitches caused staff to revert to paper records for a time, increasing the risk of error, according to the paper.

  • "How Common are Electronic Health Records in the United States? A Summary of the Evidence"
    Ashish Jha and others, Health Affairs, Vol. 25: 6, 2006
    Free abstract available at: content.healthaffairs.org/cgi/reprint/25/6/w496

    This web-exclusive article from Health Affairs identifies recent surveys on EHR adoption, assesses their quality, and synthesizes key findings to provide a national estimate of EHR adoption. The authors conclude that through 2005, 23.9 percent of physicians used EHRs in the ambulatory setting, while 5 percent of hospitals used computerized physician order entry.

  • "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs"
    Richard Hillestad and others, Health Affairs, Vol. 24: 5, 2005
    Free abstract available at: content.healthaffairs.org/cgi/content/full/24/5/1103

    This article assesses the health and financial benefits of implementing electronic medical record systems. The authors conclude that in addition to helping to coordinate care, ensure quality and reduce medical errors, electronic medical records have the potential to lower costs drastically.

Computerized Physician Order Entry (CPOE)

  • "Computer Physician Order Entry: Fact Sheet"
    The Leapfrog Group, 2007
    www.leapfroggroup.org/media/file/
    Leapfrog-Computer_Physician_Order_Entry_Fact_Sheet.pdf

    This fact sheet, put together by The Leapfrog Group, outlines key findings from several recent studies on computerized physician order entry, including one study that showed that implementation of CPOE systems at all non-rural U.S. hospitals could prevent between 570,000 and 907,000 serious medication errors each year. The authors also discuss barriers to implementation.

  • "Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review"
    Saeid Eslami and others, Journal of the American Medical Informatics Association, Vol. 14:4, April 2007.
    Free abstract available at: www.jamia.org/cgi/content/abstract/14/4/400

    This paper provides a systematic literature review of CPOE evaluation studies and finds only one study showing significant reduction in medication errors due to CPOE adoption. The authors conclude that further research is needed to determine the full impact of CPOE systems.

  • "U.S. Adoption of Computerized Physician Order Entry Systems"
    David Cutler and others, Health Affairs, Vol. 24: 6, 2005
    Free abstract available at: content.healthaffairs.org/cgi/content/abstract/24/6/1654

    Though CPOE systems have the potential to reduce medical errors, implementation rates remain low. This article empirically examines possible explanations for low adoption rates in hospitals, focusing on hospital ownership, teaching status, profitability and the reimbursement system.

  • "Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors"
    Ross Koppel and others, Journal of the American Medical Association, Vol. 293: 10, March 2005
    jama.ama-assn.org/cgi/reprint/293/10/1197

    While several studies have pointed to the expected safety benefits of CPOE systems, few have assessed whether such systems might themselves exacerbate medication errors. This study addresses this issue and finds 22 types of medication error risks associated with the implementation of CPOE systems. (7 pages)

  • "Unexpected Increased Mortality after Implementation of a Commercially Sold Computerized Physician Order Entry System"
    Yong Han and others, Pediatrics, Vol. 116: 6, December 2005
    www.pediatrics.aappublications.org/cgi/reprint/116/6/1506

    In this article, the authors argue that the implementation of a CPOE system resulted in increased pediatric mortality rates. Though careful to consider the limitations of their study, the authors point out that CPOE implementation is highly complex and consequently requires careful monitoring. (9 pages)

  • "Computerized Provider Order Entry Implementation: No Association with Increased Mortality Rates in an Intensive Care Unit"
    Mark Del Beccaro and others, Pediatrics, Vol. 118: 1, July 2006
    www.pediatrics.aappublications.org/cgi/reprint/118/1/290

    This study was conducted in response to the disturbing findings of the 2005 Han et al. study (listed above) and was similarly designed. Both children's hospitals implemented the same commercially available CPOE product and tested its efficacy in a pediatric intensive care setting. The authors found no association between implementing a new CPOE system and patient mortality. (8 pages)

Personal Health Records (PHRs)

  • "Perspectives on the Future of Personal Health Records"
    Michael Barrett and others, iHealthReports, June 2007
    www.chcf.org/documents/chronicdisease/PHRPerspectives.pdf

    Personal health records (PHRs) enable patients to store private health information securely and to share this information with multiple health care providers at the patient's discretion. Though PHRs enable patients to be more involved in their own care, questions remain about whether they might disrupt the patient-provider relationship. Furthermore, PHRs raise serious privacy concerns. This article serves as a solid background report on PHRs. (29 pages)

  • "Microsoft Rolls Out Personal Health Records"
    Steve Lohr, The New York Times, October 4, 2007
    www.nytimes.com/2007/10/04/technology/04nd-soft.html?
    ex=1349236800&en=a2e0ff5e7e643bc6&ei=5088&partner=rssnyt&emc=rss

    On October 4, 2007, Microsoft launched the nation's first major personal health record platform: Microsoft Health Vault. The platform allows users to conduct secure health-related searches and to build their own personal health records online. Microsoft Health Vault is available to all users free of charge at www.healthvault.com.

  • "How to Create Your Own Personal Health Record"
    Matthew Shulman, U.S.News and World Report, September 11, 2007
    health.usnews.com/articles/health/2007/09/11/
    how-to-create-your-own-personal-health-record.html

    This article alerts consumers to the benefits of creating a personal health record. The author mentions several platforms currently available for setting up PHRs and also discusses how such technologies will improve patient-provider communication. However, patients should note privacy policies, the article warns.

  • "Connecting Americans to Their Health Care: A Common Framework for Networked Personal Health Information"
    Josh Lemieux and others, Markle Foundation, December 7, 2006
    Study Summary: www.markle.org/downloadable_assets/research_doc_120706.pdf
    News Release: www.markle.org/downloadable_assets/news_release_120706.pdf

    At its national conference, Connecting Americans to Their Health Care: Empowered Consumers, Personal Health Records and Emerging Technologies, the Markle Foundation and its collaborators released a study showing that the American public overwhelmingly wants access to personal health information electronically and believes such information could improve health care efficiency. Furthermore, the Markle Foundation also released a comprehensive report describing what an integrated network where consumers have access to their personal health information might look like. For the full 41-page report, which includes policy implications, go to: http://www.connectingforhealth.org/commonframework/docs/P9_NetworkedPHRs.pdf

Health Information Exchange

  • "Privacy, Security, and the Regional Health Information Organization"
    Sheera Rosenfeld and others, California HealthCare Foundation, June 2007
    www.chcf.org/documents/chronicdisease/RHIOPrivacySecurity.pdf

    Regional health information organizations (RHIOs), which promote electronic exchange of patient information among participants, are grappling with a variety of privacy and security issues as they evolve. This study, based on a literature review, interviews, and an informal survey, examines some of the key issues that nine RHIOs encountered and their strategies for managing them. (33 pages)

  • "Regional Health Information Organizations: A Vehicle for Transforming Health Care Delivery?"
    Michael Solomon, Journal of Medical Systems, 2007
    www.springerlink.com/content/18075347129222tr/fulltext.pdf

    This paper assesses the impact of three emerging RHIOs: Indiana Health Information Exchange, Inc., The Massachusetts Health Data Consortium, Inc., and Santa Barbara County Care Data Exchange. The author claims that RHIOs have great potential to transform the American health care system, although cautions that they are in their infancy. (13 pages)

  • "The Santa Barbara County Care Data Exchange: Lessons Learned"
    Robert Miller and Bradley Miller, California HealthCare Foundation, August 2007
    www.chcf.org/documents/chronicdisease/SantaBarbaraLessonsLearned.pdf

    This article provides a comprehensive, independent evaluation of the Santa Barbara County Care Data Exchange, one of the nation's first RHIOs, which ceased operations on December 31, 2006. Despite its closure, the project helped to focus national attention on the value of health information exchange, which led to the federal government's adoption of a plan to establish RHIOs throughout the United States. The report provides a detailed history of Santa Barbara's data exchange; examines the organizational, technical, and legal factors leading to its closure; and considers the policy implications for nascent RHIOs elsewhere. (26 pages)

  • "Media Release: Rhode Island Moves Forward with Development of Statewide Health Information Exchange System"
    Rhode Island Department of Health, July 2007
    www.intersystems.com/press/2007/ri_hie.html

    This press release describes the development of Rhode Island's health information exchange, a system that would allow providers to access patient information (with permission) from a variety of sources when and where needed.

Health IT and Costs

  • "Health Care Spending and Use of Information Technology in OECD Countries"
    Gerard Anderson and others, Health Affairs, May 10, 2006
    www.commonwealthfund.org/publications/publications_show.htm?doc_id=372221

    In this analysis supported by The Commonwealth Fund, the authors present U.S. spending on health information technology in an international context. They also discuss the key issues in health IT implementation: creating incentives, ensuring interoperability and protecting patient privacy.

  • "Return on Investment for a Computerized Physician Order Entry System"
    Rainu Kaushal and others, Journal of the American Medical Informatics Association, Vol. 13, 2006
    Free abstract available at: www.jamia.org/cgi/content/abstract/13/3/261

    This study assesses the implementation costs and financial benefits of the CPOE system at Brigham and Women's Hospital over 10 years. It finds substantial savings associated with the CPOE system.

  • "Health Information Technology: Can HIT Lower Costs and Improve Quality?"
    RAND Corporation, 2005
    www.rand.org/pubs/research_briefs/2005/RAND_RB9136.pdf

    This research brief summarizes the key findings of several major studies sponsored by the RAND Corporation assessing potential cost savings associated with health IT. The brief highlights projected saving of at least $77 billion annually. Links to the full reports are listed in the bibliography.

Health IT and Patient Privacy

  • "Health Information Technology: Early Efforts Initiated but Comprehensive Privacy Approach Needed for National Strategy"
    Government Accountability Office, January 2007
    www.gao.gov/new.items/d07 238.pdf

    This report addresses privacy concerns inherent in the implementation of new health IT systems. It discusses steps taken at the national level to address the issue of privacy and identifies challenges associated with protecting electronic personal health information. (57 pages)

  • "Warnings Over Privacy Of U.S. Health Network"
    Robert Pear, New York Times, February 18, 2007
    www.nytimes.com/2007/02/18/washington/18health.html?_r=1&ex=1176004800&en=47636a4ca1a9b3d1&ei=5070&oref=slogin

    This article reports on a January 2007 report from the Government Accountability Office (listed above). According to the report, "the Bush administration has no clear strategy to protect the privacy of patients as it promotes the use of electronic medical records throughout the nation's health care system."

  • "Private Health Records: Privacy Implications of the Federal Government's Health Information Technology Initiative"
    Carol Diamond, Markle Foundation, February 1, 2007
    www.markle.org/downloadable_assets/caroldiamond_february12007final.pdf

    Carol Diamond, managing director of the Markle Foundation, testifies before a Senate committee on Markle's strategy for expanding health IT and maintaining patient privacy. In her testimony, Diamond reminds the committee that while the American public is largely in support of EHR use, there remain significant privacy concerns. She then explains how Markle's "Common Framework" for secure, authorized, and private health information sharing addresses these concerns. (26 pages)

  • "eHVRP Study Finds Healthcare Industry Must Do More to Protect Electronic Health Record Systems"
    eHealth Vulnerability Reporting Program, September 2007
    News Release: www.prwebdirect.com/releases/2007/9/prweb554028.php

    The board of the eHealth Vulnerability Reporting Program has made public the results of a 15-month study assessing the security risks associated with electronic health record (EHR) systems. Overall, the study concludes that commercial EHR systems have significant security vulnerabilities. The study evaluated current industry information security practices, assessed level of risk related to EHR systems, benchmarked health care information security practices against other industries, and produced a set of recommendations relating to activities beneficial to protecting information systems in the healthcare industry. The full report is available at: www.ehvrp.org/report.html (39 pages)

The Future of Health IT

  • "At the Helm"
    Healthcare Informatics, September 2007
    www.healthcare-informatics.com

    In this cover article, Robert Kolodner, M.D., head of the Office of the National Coordinator for Health Information Technology (ONC), talks about his plans for the future. In particular, he discusses the American Health Information Community's (AHIC) potential move into the private sector.

  • "Congress Moves on Health IT: One Step Forward, A Few Steps Back"
    Bruce M. Fried, iHealthBeat, July 2007
    www.ihealthbeat.org/articles/2007/7/18/Congress-Moves-on-Health-IT-One-Step-Forward-A-Few-Steps-Back.aspx?ps=1&authorid=1570#

    This article discusses current health IT bills in the House and the Senate. The author says that the legislation is encouraging but emphasizes the pressing need for funding of health IT at the national level.

  • "Health IT bill advances in Senate; grants have bipartisan support"
    Dave Hansen, American Medical News, July 2007
    www.ama-assn.org/amednews/2007/07/16/gvsa0716.htm

    This article discusses the Wired for Health Care Quality Act, which would authorize $278 million to help subsidize the cost of health IT for physicians and hospitals. Furthermore, the article discusses the privacy provisions of the bill, which extend HIPAA privacy rules to the digital realm and mandate that patients be notified when their privacy is jeopardized.

  • "Lawmakers focus on federal role in promoting health IT systems"
    Dave Hansen, American Medical News, July 2007
    www.ama-assn.org/amednews/2007/07/02/gvsc0702.htm

    This article discusses recent legislative developments in health IT, specifically Sen. Sheldon Whitehouse's National Health Information Technology and Privacy Advancement Act of 2007 and Reps. Dennis Moore and Paul Ryan's Independent Health Record Trust Act.

  • "Health Information Technology Initiative: Major Accomplishments, 2004-2006"
    U.S. Department of Health and Human Services, 2006
    www.hhs.gov/healthit/news/Accomplishments2006.pdf

    This report summarizes the major accomplishments of the Health Information Technology Initiative, implemented by the U.S. Department of Health and Human Services. It describes the role the federal government has played in implementing and encouraging health IT, including the formation of the Office of the National Coordinator for Health IT (ONC) and the American Health Information Community (AHIC).

  • "Health Information Technology: What is the Federal Government's Role?"
    David Blumenthal, The Commonwealth Fund, March 2006
    www.commonwealthfund.org/usr_doc/Blumenthal_HIT_907.pdf?section=4039

    In this report, David Blumenthal, director of the Mass. General/Partners Institute for Health Policy, discusses what role the federal government should play in helping to implement health IT. He concludes with a discussion of recent federal legislation, suggesting that the government could intervene more aggressively to help correct market failures in health care.

  • "U.S. Presidential Candidates' Health Plans: Incorporating Information Technology to Provide 21st Century Care"
    Susan Blumenthal, Center for the Study of the Presidency, July 2007
    www.thepresidency.org/Agenda2008/Agenda2008healthIT.html

    This commentary by Susan Blumenthal, MD, MPA, examines the 2008 presidential candidates' health plans with respect to health IT as of July 2007. Included are side-by-side comparisons of the candidates' proposals and speculation about the future role of health IT in the American health care system.

Story Ideas

  • What types of health IT have been adopted by local hospitals and physician groups in your area? At what cost? Has use of these technologies improved services and the quality of care received?
  • How do patients in your area feel about health IT? Do they have privacy concerns related to widespread use of electronic patient records? What are administrators and providers doing to allay these concerns?
  • Are providers in your area worried that storing patient data digitally will increase their risk of lawsuits?
  • Are there any local initiatives sponsoring the adoption of health IT in your area? Who is paying for the upfront costs involved?
  • Do regulations, such as those regarding prescription writing, stand in the way of health IT adoption in your state?
  • Are local companies involved in developing new health information technologies?
  • If you have a veterans hospital in your area, to what extent has the VA's use of health IT improved care there?
  • According to stakeholders and consumer advocates in your area, what parts of health IT should remain at the regional or local level, and what parts should be integrated at the national level?
  • Are local or state public health agencies using IT to track or detect disease outbreaks? If so, are their efforts succeeding?

Selected Experts

Analysts/Advocates

  • ZOE BAIRD
    President
    The Markle Foundation
    212-713-7600
    zbaird@markle.org
  • DON BERWICK
    President and CEO
    Institute for Healthcare Improvement
    617-301-4800
    dberwick@ihi.org
  • DAVID BLUMENTHAL
    Director
    Institute for Health Policy, Mass. General Hospital
    617-726-5212
  • CARMELLA BOCCHINO
    Senior Vice President
    America's Health Insurance Plans
    202-778-3278
    cbocchino@ahip.org
  • PATRICIA F. BRENNAN
    University of Wisconsin-Madison
    School of Nursing
    608-263-1315
  • JANET MARCHIBRODA
    Chief Executive Officer
    eHealth Initiative and Foundation
    202-624-3270
    janet.marchibroda@ehealthinitiative.org
  • JANET CORRIGAN
    President
    National Quality Forum
    202-783-1300
    janetcorrigan@qualityforum.org
  • DON DETMER
    President and CEO
    American Medical Informatics Association
    301-657-1291
    detmer@amia.org
  • CAROL DIAMOND
    Managing Director
    Health Program, The Markle Foundation
    212-713-7600
    cdiamond@markle.org
  • LOUIS DIAMOND
    Vice President and Medical Director
    Thomson Medstat
    202-719-7833
    louis.diamond@thomson.com
  • STEPHEN DOWNS
    Deputy Director, Health Group
    Robert Wood Johnson Foundation
    609-627-7636
    sdowns@rwjf.org
  • COLIN EVANS
    Director, System Software
    Corporate Technology Group, Intel
    503-264-6161
    colin.evans@intel.com
  • NEWT GINGRICH
    Founder
    Center for Health Transformation
    202-375-2001
  • PAUL GINSBURG
    President
    Center for Studying Health System Change
    202-484-4699
    pginsburg@hschange.org
  • PETER GOLDSCHMIDT
    Founder/President
    Health Improvement Institution
    301-320-0971
    pgg@hii.org
  • MARY GREALY
    President
    Healthcare Leadership Council
    202-452-8700
    mgrealy@hlc.org
  • BILL HEAD
    Vice President of Policy and Governmental Affairs, National Alliance for Health Information Technology (NAHIT)
    202-661-7074
    bhead@nahit.org
  • DAVID HELMS
    President and CEO
    AcademyHealth
    202-292-6748
    david.helms@academyhealth.org
  • KEVIN B. JOHNSON
    Associate Professor & Vice Chair of Biomedical Informatics, Associate Professor of Pediatrics
    Vanderbilt University
    615-936-3596
    kevin.b.johnson@vanderbilt.edu
  • SAM KARP
    Vice President of Programs
    California HealthCare Foundation
    510-238-1040
    skarp@chcf.org
  • KALA LADENHEIM
    Program Director
    National Conference of State Legislatures
    202-624-3557
    kala.ladenheim@ncsl.org
  • DAVID LANSKY
    Director of Health
    The Markle Foundation
    212-713-7600
    dlansky@markle.org
  • THOMAS LEE
    Senior Program Officer
    California HealthCare Foundation
    510-238-1040
  • GWENDOLYN LOHSE
    Program Director
    Council for Affordable Quality Healthcare
    202-861-1492
    glohse@caqh.org
  • DENNIS O'LEARY
    President
    Joint Commission on Accreditation of Healthcare Organizations
    630-792-5650
    doleary@jcaho.org
  • J. MARC OVERHAGE
    Associate Professor
    Indiana University School of Medicine
    Director, Medical Informatics
    Regenstrief Institute
    317-630-8685
    joverhag@iupui.edu
  • JONATHAN PERLIN
    Senior Vice President & Chief Medical Officer
    Hospital Corporation of America Healthcare
    615-344-1212
    johnathan.perlin@hcahealthcare.com
  • MICHAEL POLLARD
    Consultant, Federal Policy and Regulation
    Medco Health Solutions
    202-639-1884
    michael_pollard@medco.com
  • JOY PRITTS
    Director and Founder
    Ctr. of Medical Rights & Privacy -- Georgetown Univ.
    202-687-0880
    jlp@georgetown.edu
  • DAN RODE
    Vice President of Policy and Governmental Affairs
    American Health Information Management Association
    202-659-9440
    dan.rode@ahima.org
  • DAVID SCHULKE
    Executive Vice President
    American Health Quality Association
    202-331-5790
    dschulke@ahqa.org
  • WILLIAM STEAD
    Associate Vice Chancellor for Health Affairs, Chief Information Officer
    Vanderbilt University Medical Center
    615-936-1424
    bill.stead@vanderbilt.edu
  • WALID TOHME
    Division Director & Associate Professor
    ISIS Center, Georgetown University
    202-687-0721
    tohme@isis.imac.georgetown.edu
  • GORDON VINEYARD
    Board of Directors
    Massachusetts Health Data Consortium
    781-890-6040
  • JONATHAN WEINER
    Professor, Director PhD Program in Health Services Research & Policy
    Johns Hopkins University Bloomberg School of Public Health
    410-955-5661
    jweiner@jhsph.edu

Government and Related Groups

  • CAROLYN CLANCY
    Director
    Agency for Healthcare Research and Quality
    301-427-1200
    carolyn.clancy@ahrq.hhs.gov
  • KELLY CRONIN
    Director
    Office of Programs and Coordination, Office of the National Coordinator for HIT
    202-690-7151
    kelly.cronin@hhs.gov
  • CAROL HABERMAN
    Senior Program Analyst
    Health Resources and Services Administration (HRSA)
    301-443-0076
    chaberman@hrsa.gov
  • ROBERT KOLODNER
    National Coordinator
    Office of the National Coordinator for HIT
    202-690-7151
  • FARZAD MOSTASHARI
    Assistant Commissioner and Chair
    Primary Care Information Taskforce Epidemiology Services
    New York City Department of Health
    212-788-7837
  • LARRY PATTON
    Senior Advisor to the Director
    Agency for Healthcare Research and Quality
    202-260-7251
    lpatton@ahrq.gov
  • DENA PUSKIN
    Director of the Office for the Advancement of Telehealth
    Health Resources and Services Administration (HRSA)
    301-443-0447
    dpuskin@hrsa.gov
  • WILLIAM ROLLOW
    Director, Quality Improvement Group
    Centers for Medicare and Medicaid Services
    410-786-0773
    william.rollow@cms.hhs.gov

Stakeholders

  • HOLT ANDERSON
    Executive Director
    N.C. Healthcare Information and Comm. Alliance
    919-558-9258 x27
    wha@nchica.org
  • WENDY ANGST
    General Manager
    Cap Med
    877-227-6336
  • GLORIA AUSTIN
    CEO
    Brown & Toland
    415-972-4300
  • EDWARD N. BARTHELL
    Executive Vice President of Strategy & Clinical Affairs Infinity Healthcare
    College of Emergency Physicians
    414-290-6700
  • PETER BASCH
    Medical Director
    eHealth Medstar Health
    202-546-4504
  • MARC BOUTIN
    Vice President of Policy Development and Advocacy
    National Health Council
    202-785-3910
    mboutin@nhcouncil.org
  • WILLIAM S. BERNSTEIN
    Partner
    Manatt, Phelps & Phillips
    310-312-4000
    wbernstein@manatt.com
  • FRANCOIS DE BRANTES
    National Coordinator
    Bridges to Excellence
    francois.debrantes@corporate.ge.com
  • MARK FRISSE
    Accenture Professor of Biomedical Informatics
    Vanderbilt Center for Better Health
    615-343-1528
    mark.frisse@vanderbilt.edu
  • JOHN GLASER
    Vice-President and Chief Information Officer
    Partners Healthcare System
    617-278-1000
    jglaser@partners.org
  • JOHN HALAMKA
    Chief Information Officer
    CareGroup Health System
    Chief Information Officer
    Harvard Medical School
    Chairman
    New England Health Electronic Data Interchange Network
    617-754-8002
    jhalamka@caregroup.harvard.edu
  • MATT HANDLEY
    Associate Medical Director
    Group Health Cooperative
    206-448-6135
  • BRUCE KELLY
    Director of Government Relations
    Mayo Clinic
    202-327-5424
  • DAVID KIBBE
    Director of Health Information Technology
    American Academy of Family Physicians
    919-960-5290
    dkibbe@aafp.org
  • ALLAN KORN
    Senior Vice President & Chief Medical Officer
    Blue Cross Blue Shield Association
    312-297-6000
    allan.korn@bcbsa.com
  • MARK LEAVITT
    Chair
    Certification Commission for Healthcare Information Technology
    312-233-1582
  • NED MCCULLOCH
    Senior Program Manager
    Government Programs Office, IBM
    202-515-4019
    nmcculloch@us.ibm.com
  • NEAL NEUBERGER
    President
    Health Tech Strategies, LLC
    703-538-0917
  • JAMES RALSTON
    Assistant Investigator
    Group Health Cooperative
    206-287-2076
  • WES RISHEL
    Vice President and Research Area Director
    Gartner Healthcare
    203-316-1288

Selected Websites

Glossary on Health Information Technology

(Adapted in part from "Selected Health Information Technology Terms" by Peter B. Gallagher -- www.pinellashealth.com/RHIO/Terminology_Master.pdf)

CARRIER - An entity which may underwrite or administer a range of health benefit programs. May refer to an insurer or a managed health plan.

AMERICAN HEALTH INFORMATION COMMUNITY (AHIC) - A federally chartered advisory committee that makes recommendations to the secretary of the U.S. Department of Health and Human Services on how to make health records digital and interoperable, encourage market-led adoption and ensure that the privacy and security of those records are protected at all times.

COMMISSION ON SYSTEMIC OPERABILITY - Authorized by the Medicare Modernization Act of 2003, the commission was charged with developing strategies to make healthcare information instantly accessible at all times, by consumers and their healthcare providers. The group's 12 recommendations and a discussion of the benefits of an interoperable network and the barriers to creating such a network were published in 2005 in a report "Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Technology" (http://endingthedocumentgame.gov).

COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) - A computerized system that allows a physician's orders for services such as medications, laboratory tests and other tests to be entered electronically instead of being recorded on order sheets or prescription pads. This allows for the order to be compared against standards for dosing and to be checked for any patient allergies or interactions with other medications, or other potential problems if the order is filled.

CONNECTIVITY - The physical network and operating rules allowing computerized health information to be stored at one point and retrieved at another by an authorized user. For some people in the health IT field, connectivity implies having uniform privacy laws protecting individually identifiable medical information from be accessed by unauthorized persons.

ELECTRONIC HEALTH RECORD (EHR) - In health informatics, an electronic health record refers to the subset of a patient's electronic medical record (EMR) that is integrated into a larger information network and owned by the patient. In common usage, EHRs and EMRs are used interchangeably to refer to a patient's medical record in digital format. Efforts are underway to develop consensus definitions for these terms and others. See definitions.nahit.org/ for more information. See "fully operational electronic health record system." Contrast with "electronic medical record" and "personal health record."

ELECTRONIC MEDICAL RECORD (EMR) - An electronic medical record refers to a patient's legal medical record, stored in digital format. It serves as a repository for clinical data and may have additional capacities such as computerized physician order entry (CPOE) and clinical decision support. Efforts are underway to develop consensus definitions for this term and others. See definitions.nahit.org/ for more information. See "fully operational electronic health record system." Contrast with "electronic health record" and "personal health record."

FULLY OPERATIONAL ELECTRONIC HEALTH RECORD SYSTEM - One that collects patient information, displays test results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions.

HEALTH INFORMATION EXCHANGE (HIE) - Health information exchange is defined as the mobilization of healthcare information digitally across organizations within a region or community. HIE provides the capability to move clinical information between separate health care information systems while maintaining the meaning of the information being exchanged.

HEALTH INFORMATION TECHNOLOGY (HIT) - Information processing using both computer hardware and software for the entry, storage, retrieval, sharing, and use of health care information. Two common components of HIT are electronic medical records and computerized physician order entry.

INTEROPERABILITY - The ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.

NATIONAL HEALTH INFORMATION NETWORK (NHIN) - The technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and health care. The vision for the NHIN is said to have begun in 1991 with the publication of an Institute of Medicine report, "The Computer-Based Patient Record." The path to a national network of health care information is through the successful establishment of regional health information organizations.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY (ONC) - Provides counsel to the secretary of the U.S. Department of Health and Human Services and others within the department for the development and nationwide implementation of an interoperable health information technology infrastructure. The ONC also provides management of and logistical support for the American Health Information Community (AHIC).

PERSONAL HEALTH RECORD (PHR) - A PHR is a health record that is "owned" and maintained by an individual patient, rather than by payers or providers. Though the term has been around for several decades, it has recently received renewed attention with the adoption of electronic health records.

REGIONAL HEALTH INFORMATION ORGANIZATION (RHIO) - A RHIO is a multi-stakeholder organization, operating in a specific geographical area, that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. Officials from the U.S. Department of Health and Human Services see RHIOs as the building blocks for the National Health Information Network (NHIN). When complete the NHIN will provide universal access to electronic health records.

Endnotes

1 "Health Information Technology in the United States: The Information Base For Progress," Robert Wood Johnson Foundation, October 2006. Available at: www.rwjf.org/files/publications/other/EHRReport0609.pdf. Retrieved September 20, 2007.

2 D.W. Bates et al., "Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors." Journal of the American Medical Association 280:15 (1998): 1311-1316. Abstract available at: jama.ama-assn.org/cgi/content/abstract/280/15/1311. Retrieved September 20, 2007.

3 A.K. Jha et al., "How Common Are Electronic Health Records in the United States? A Summary of the Evidence," Health Affairs 25:6 (2006): w496-w507. Abstract available at: content.healthaffairs.org/cgi/content/abstract/25/6/w496. Retrieved September 20, 2007.

4 Research Brief, "Health Information Technology: Can HIT Lower Costs and Improve Quality?" RAND Corporation (2005). Available at: www.rand.org/pubs/research_briefs/2005/RAND_RB9136.pdf. Retrieved September 20, 2007.

5 G. Anderson et al., "Health Care Spending and Use of Information Technology In OECD Countries," Health Affairs 25:3 (2006): 819-831. Abstract available at: content.healthaffairs.org/cgi/content/full/25/3/819 Retrieved September 20, 2007.

6 Ross Koppel and others, "Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors."Journal of the American Medical Association, Vol. 293: 10, March 2005. jama.ama-assn.org/cgi/reprint/293/10/1197 ; "Kaiser Has Aches, Pains Going Digital," Los Angeles Times, February 15, 2007. Summarized at www.medicalnewstoday.com/articles/63273.php

7 Hillestad et al. "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs," Health Affairs, 24:5 (2005): 1103-1117. Abstract available at: content.healthaffairs.org/cgi/content/abstract/24/5/1103 Retrieved September 20, 2007.

8 Dave Garets and Mike Davis, "Electronic Medical Records vs. Electronic Health Records: Yes, There is a Difference," HIMSS Analytics White Paper, January 26, 2006. Available at: www.himssanalytics.org/docs/WP_EMR_EHR.pdf. Retrieved December 10, 2007.

9 The Office of the National Coordinator of Health Information Technology (ONC) recently hired the National Alliance for Health Information Technology (NAHIT) to lead an effort to reach consensus definitions for the following terms: electronic health record (EHR), electronic medical record (EMR), personal health record (PHR), regional health information organization (RHIO), and health information exchange (HIE). More information about this project, which is set to conclude in March 2008, can be found here: definitions.nahit.org/

10 David Blumenthal and John Glaser, "Information Technology Comes to Medicine," The New England Journal of Medicine Vol. 356:24, June 14, 2007.

11 D.W. Bates et al., "Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors." Journal of the American Medical Association 280:15 (1998): 1311-1316. Abstract available at: jama.ama-assn.org/cgi/content/abstract/280/15/1311 Retrieved September 20, 2007.

12 "Continued Progress: Hospital Use of Information Technology," American Hospital Association (2007) Available at: www.aha.org/aha/research-and-trends/ Retrieved September 20, 2007; "Health Information Technology in the United States: The Information Base For Progress," Robert Wood Johnson Foundation, October 2006. Available at: www.rwjf.org/files/publications/other/EHRReport0609.pdf Retrieved September 20, 2007.

13 A.K. Jha et al., "How Common Are Electronic Health Records in the United States? A Summary of the Evidence," Health Affairs 25:6 (2006): w496-w507. Abstract available at: content.healthaffairs.org/cgi/content/abstract/25/6/w496. Retrieved September 20, 2007.

14 G. Anderson et al., "Health Care Spending and Use of Information Technology In OECD Countries," Health Affairs 25:3 (2006): 819-831. Abstract available at: content.healthaffairs.org/cgi/content/full/25/3/819 Retrieved September 20, 2007.

15 Nancy Ferris, "Senators and administration agree: Require e-prescribing in Medicare," Government Health IT, December 5, 2007. Available at: www.govhealthit.com/online/news/350139-1.html. Retrieved December 7, 2007.

16 Tommy Thompson et al., "The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care," Department of Health and Human Services (21 July 2004). Available at: www.hhs.gov/healthit/documents/hitframework.pdf. Retrieved September 20, 2007.

17 Robert Miller et al. "The Value of Electronic Health Records in Solo or Small Group Practices," Health Affairs Vol. 24: 5 (2005): 1127-1136. Abstract available at: content.healthaffairs.org/cgi/content/full/24/5/1127 Retrieved September 20, 2007.

18 R Kaushal et al., "The Costs of a National Health Information Network" Annals, 143 (2005) 165-173. Abstract available at: www.annals.org/cgi/reprint/143/3/165.pdf Retrieved September 20, 2007.

19 eHealth Vulnerability Reporting Program, "eHealth Vulnerability Reporting Program: Executive Briefing Document," September 2007. www.ehvrp.org/report.html; Markle Foundation, "Prepared Statement of Carol C. Diamond, MD, MPH: Private Health Records: Privacy Implications of the Federal Government's Health Information Technology Initiative." Testimony before the Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia of the Senate Homeland Security and Governmental Affairs Committee. February 1, 2007. www.markle.org/downloadable_assets/caroldiamond_february12007final.pdf

20 A.K. Jha et al., "Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care," New England Journal of Medicine 348:22 (29 May 2003). Abstract available at: content.nejm.org/cgi/content/abstract/348/22/2218 Retrieved September 20, 2007.

21 The Associated Press, "Hurricane highlights need for digital health records," 13 September 2005. Available at: www.msnbc.msn.com/id/9316246/ Retrieved October 5, 2007.

22 "Immunization Information Systems" Pediatrics 118 (2006). Retrieved September 20, 2007. Available at: pediatrics.aappublications.org/cgi/reprint/118/3/1293. Retrieved September 20, 2007.