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

Alliance for Health Reform www.allhealth.org/issues.asp?wi=4
AFL-CIO www.aflcio.org
American Academy of Family Physicians, Center for Health IT www.centerforhit.org
American Hospital Association www.aha.org/aha_app/issues/HIT/index.jsp
American Medical Association www.ama-assn.org
Blue Cross Blue Shield Association www.bcbs.com/issues/healthit
Bridges to Excellence www.bridgestoexcellence.org
The Commonwealth Fund, Health IT Selected Resources www.commonwealthfund.org/General/General_show.htm?doc_id=289934
Health Affairs www.healthaffairs.org
Health Data Management www.healthdatamanagement.com
Health Management Technology www.healthmgttech.com
Heritage Foundation www.heritage.org
Institute for Health Policy Solutions www.ihps.org
JCAHO www.jcaho.org
Kaiser Family Foundation www.kff.org
The LeapFrog Group www.leapfroggroup.org
The Markle Foundation www.markle.org
National Alliance for the Health Information Technology www.nahit.org
Project HealthDesign www.projecthealthdesign.org
RAND Corporation www.rand.org
Robert Wood Johnson Foundation www.rwjf.org
U.S. Department of Health and Human Services www.hhs.gov/healthit
Urban Institute www.urban.org

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.