A REPORTER'S TOOLKIT: HEALTH INFORMATION TECHNOLOGY

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

The resources in this toolkit will help you understand how health information technology (IT) is slowly changing health care, and how analysts disagree about the value of some technologies. We offer you an introduction to issues such as protecting patient privacy and the cost of new technologies. This resource also offers story ideas, selected experts with contact information, selected websites of interest and a glossary.

This toolkit was compiled and written by Sam Takvorian.

 
Table of Contents

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.

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

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

Computerized Physician Order Entry (CPOE)

Personal Health Records (PHRs)

Health Information Exchange

Health IT and Costs

Health IT and Patient Privacy

The Future of Health IT

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.