The late August signing of the "Executive Order: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs" by President Bush supports the administration's goal of an electronic health record for every American by 2014. It also supports the end goal of a nationwide data-sharing network.
But at most, it's one more affirmative step toward those goals. The order prioritized the value of healthcare IT and also included two other main points — transparency in care quality and price and access to relevant information. Its greatest specificity is its effective date, Jan. 1, 2007. Otherwise, its directives function as little more than a strategic pointer for federal agencies, and those who contract with them.
Covered entities include federal agencies that administer or sponsor a federal healthcare program. This includes the military health service, the Indian Health Service and the federal employee health programs and, of course, the Department of Health and Human Services, which underwrites about 40 percent of the healthcare in this country through the Centers for Medicare and Medicaid Services' programs.
So, like other mandates, decrees, legislation and directives that tie compliance to federal funding, this has the potential to be far-reaching. Affected agencies are charged with promoting quality and care efficiency through standards-based IT, but there are no deadlines and no imperatives.
Overall, it's a nice document to set the tone for continued progress toward data sharing goals but leaves lots of wiggle room. The order states, "As each agency implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards." Similar wording charges each agency to require contracted providers, plans and health insurance issuers to work to the same standard.
An example of what might be accomplished is seen in one of the key federal agencies included in the directive. That, of course, is the Department of Health and Human Services' Department of Veterans Affairs (VA). Once characterized by poor standards of care and a treatment center of last resort, the VA has now achieved high praise for its quality care and efficiency. Although the VA's top-level leadership was critical in setting goals that turned the health system around, the VA-developed VistA system, first introduced 10 years ago, plays a key supporting role for day-to-day operations.
Physicians who have become accustomed to the accessibility to patient data offered across the VA system report deep disappointment and dismay when entering private practices after VA posts. And remember: The VA delivered seamless care in the wake of Hurricanes Katrina and Rita last year thanks to digital records.
Had you asked me 20 — even 10 — years ago, I would have been confident that all healthcare records would be digital and accessible by now. I couldn't have imagined that only 20 percent or so of office-based physicians use electronic medical records. Although the adoption rate for this group climbs a bit every year, there have been no high-drama moments.
Although this recent Executive Order sets the administration's stamp of approval on what should be obvious strategies among federal agencies, it will function, as have many other Executive Orders before it, as a directional milepost along the road toward electronic systems, connectivity and data sharing.