As gatherings of government officials and healthcare information technology thought leaders go, the Third Health Information Technology Summit in Washington, D.C. was a star-studded event.
Meeting in conjunction with the 13th National HIPAA Summit and sponsored by the eHealth Initiative and its Foundation, the HIT Summit focused on policy and progress at the state and federal levels, as the HIPAA Summit focused on issues related to the decade-old HIPAA regulation. The two summits drew more than 850 attendees.
Delivering his inaugural address as the newly appointed Interim National Coordinator of Health Information Technology, Robert Kolodner, M.D., summarized progress to date on standards harmonization, certification for electronic health record (EHR) products and work on security and privacy to support the nascent national health information network.
"The next steps will be to support state-level health information exchanges," he said. Current focus is on establishing sustainable intra-state consensus building, but privacy and security are essential components, according to Kolodner. "If we do not have (privacy and security), the public will not trust it. We are not waiting for perfection, but want it to be good enough to progress. We must ensure that privacy and security standards are up-to-date and ensure breaches do not occur."
Speaking from his experience at the Veterans Health Administration (VA) where he was chief health informatics officer, Kolodner was optimistic about the goal of meeting the Bush administration's 2014 goal of an EHR for every American. "If we can bring the energy that transformed a crusty organization such as the VA to the public, many things are possible," he said.
Outgoing administrator of the Centers for Medicare and Medicaid Services, Mark McClellan, M.D., Ph.D., discussed the changing landscape and payment plans for Medicare and Medicaid. "Value-based payments are coming to Medicare on a very large scale," McClellan said. "In many of our waivers with state Medicaid, we are looking for measurable reductions — something we can't do without effective IT."
Discussing CMS' progress on e-prescribing, which is an adoption mandate under the Medicare Modernization Act of 2003, McClellan said that prescription standards issued last fall are at the core of CMS' strategy and that the agency is working to increase value for providers. Next year, CMS and the Agency for Healthcare Research and Quality (AHRQ, Rockville, Md.) plan pilots to determine the next round of standards, which include formulary details and instructions to patients, among others.
States in action
State leaders convened by geographic region into four caucuses to discuss progress, strategies and challenges in building health information exchanges (HIE). State caucus members shared how they were proceeding with plans.
Depending on source of funding and strategic business plans, states vary significantly on starting points and processes. In the eastern regional caucus, state representatives discussed what type of clinical data they chose to share. Starting points included medication history information, public health and/or Medicaid data and messaging clinical results.
Delaware, for example, went through an eight-month planning process and has involved a major reference laboratory. Rhode Island, which has an AHRQ contract that specifies prioritization of lab and medication histories, started with clinical results reporting. Massachusetts started with results delivery because state healthcare leaders wanted to address care givers' 'pain points.'
Some states, such as Vermont, have received seed funding from their state coffers. That state plans to establish an overall healthcare IT plan. It is making an investment in messaging and proposing a return on investment through cost avoidance by reaching out to the chronically ill, using messaging for preventive measures.
Other states are finding non-governmental support. Connecticut, for one, is finding financial support from corporate health plans headquartered in the state, plus donations from large employers.
Proving the value of these exchanges continues to challenge HIE leaders. New York stands out by engaging academics for the evaluation and development of common metrics.
When quality meets HIT
Physicians aren't happy to know that starting Jan. 1, reimbursements will decrease, reported Joseph Heyman, M.D., a Massachusetts-based physician and elected secretary of the American Medical Association Board of Trustees. He expressed concerns about small practices' ability to report quality measurement data, and about unintended consequences: "I am concerned about low-income people in low-income areas with populations sicker than other areas."
Margaret Van Amringe, vice president of public policy and government relations for the Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, Ill.), is more optimistic. "It's going to take more than just money to achieve goals we have set. I think we have an opportunity to build interconnected systems to enable physicians to practice the way they want to practice. The payers are really energized by this issue and they're pushing in the performance area. Pay for performance may bring some changes but will only take you so far. If we can't change the underlying system, we won't be able to transform the system."
A note of caution came from James Walker, M.D., CMO, Geisinger Health System in north central Pennsylvania. EMRs are high-maintenance items, he stated. "It's not reasonable to ask small- and medium-sized hospitals and small- and medium-sized practices to buy, implement and maintain a high-performance EHR."
And then there's the issue of safety. "Attention to safety is critical," Walker warns. "Software can create large problems without anyone being aware." Also, a successful EHR project will create more clinician demand for process improvement than managers or an IT team can keep up with, he added. And it will alter teams and stakeholder relationships due to the higher visibility of processes and results, changing values of skills and reassignment of work and responsibility.
Countdown to change
Craig Barrett took an engineering approach to healthcare transformation. The CEO of Intel, Santa Clara, Calif., urged a systematic change where the question to ask is not, 'Who pays?' but rather, 'How do we achieve efficiency and value?'
"The government is limited in what it can do in terms of mandating what must be done," he told the audience. "The folks with the purchasing power, those who are paying 50 percent of the bill, are big companies (like Intel). What we haven't done is say we're going to exercise purchasing power in driving change."
"Technology is a tool," Barrett continued. "It has changed every other industry on the face of the earth except this one and maybe elementary education. It enables healthcare to scale ... . I don't think the industry is capable of transforming itself ... and it is affecting U.S. competitiveness as a whole."
Michael Leavitt talked a lot about change from a government perspective. The Secretary of Health and Human Services, U.S. Department of Health and Human Services, told attendees, "We don't have a healthcare system: We have a healthcare sector. Part of what we're doing is to make a healthcare system." His four-point plan includes compatible systems, quality measures, price transparency and incentives.
"The forces that must drive quality are the ones that are delivering care. This must be a collaborative effort," Leavitt said. "The medical profession is working to develop quality measures and the economic community is working with them. I think within two years, we will see emerging pockets of value-based care. Within five years, value-based care will enter the lexicon and within 10 years, I believe transformation will have occurred."
Greg Goth is a contributing writer based in Oakville, Conn.