Fact Sheet
FOR IMMEDIATE RELEASE
Wednesday, July 21, 2004 |
Contact: HHS Press Office
(202) 690-6343
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HHS Fact Sheet--HIT Report At-A-Glance
"The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care"
A Framework for Strategic Action
Overview: Today HHS Secretary Tommy G. Thompson released the first outline of a 10-year plan to build a national electronic health information infrastructure in the United States. The report, "The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care," lays out the broad steps needed to achieve always-current, always-available electronic health records (EHR) for Americans. This responds to the call by President Bush this year to achieve EHRs for most Americans within a decade. The report identifies goals and action areas, as well as a broad sequence needed to achieve the goals, with joint private/public cooperation and leadership. The report was prepared by National Coordinator for Health Information Technology David J. Brailer, M.D., Ph.D., appointed in May to the new position created by the President in an April executive order. The executive order mandated today's report, and also mandated additional related reports by the Department of Veterans Affairs, Department of Defense and the Office of Personnel Management, which were also being released today.
Today's report was issued at the Secretarial Summit on Health Information Technology, convened in Washington D.C. to bring together the nation's top leaders in information technology and health care. At the Summit, Secretary Thompson also announced several new immediate actions to help accelerate health information technology adoption.
The Promise of Health Information Technology
Use of modern information technology has the potential to transform the delivery of health care in America for the better -- and to do so without heavy-handed regulation or upheaval in the health care sector:
Interoperable: With interoperable electronic health records, always-current medical information could be available wherever and whenever the patient and attending health professional needed it. At the same time, EHRs would also provide access to treatment information to help clinicians as they care for patients. Quality Care: Quality of care could be substantially improved. Medical errors and medically-caused injuries and death, which can be caused by information-related factors ranging from inadequate record availability to poor handwriting, could be dramatically reduced. The Institute of Medicine has estimated that 45,000 to 98,000 deaths occur each year due to medical errors. Decision Support: Quality of care could also be improved by providing timely and appropriate treatment information to health care professionals. With the explosion of knowledge and treatment options in health care, the Rand Corporation found that Americans get recommended care only 55 percent of the time. New technologies can feed a wealth of up-to-date treatment information directly to physicians and others as they care for patients. Cost Effective Care: Savings in the range of $140 billion per year, close to 10 percent of total U.S. health spending, could be achieved through health information technology -- by reducing duplicative care, lowering health care administration costs, and avoiding errors in care. Bench-to-Bedside: Health information technology can also be used to help accelerate biomedical research, and to bring the findings of research into bedside practice more quickly. Today it is estimated that new research findings can take as long as 17 years to be fully integrated into general medical practice. Medically Underserved: Health information technology can be especially beneficial for medically underserved areas, including inner-city and remote rural areas. Access to specialty information, including consultations between doctors in underserved areas with leading medical specialists, can mean less geographic variability in access to best quality care. Consumer Involvement: Secure "personal health records" (PHR) could be maintained by the patient and his or her physician, insurer or others, giving the patient unprecedented access and control of the record. This could mean not only better-informed consumers, but also direct consumers involvement in decision-making regarding their care. Accuracy and Privacy: Privacy, security and quality of electronic medical records could be improved over paper records through the use of technology that complies with federal laws governing privacy and security of health information. Under the federal health information privacy law, which the health care sector began implementing last year, patients have the power to authorize certain non-routine types of uses and disclosures made of their identifiable records, and misuses of individually identifiable health information, including electronic health records are punishable by law. Public Health Monitoring: Linked health information networks would enable public health agencies to better monitor disease outbreaks and act quickly in response, through computer network access to large amounts of de-identified information. This could be important for both natural disease outbreaks and possible bioterrorism.
Why Isn't Modern Health Information Technology Already in Place?
The benefits of information technology have taken hold all around us, from banks to grocery stores. But today's report states: "The innovation that has made American medical care the world's best has not been applied to its health information systems." Hospitals' use of EHRs in 2002 was reported at 13 percent; and for physicians' practices, 14 percent to a possible high of 28 percent. Among the reasons for the slow adoption:
The size and variety of America's health system provide for community ownership and resilience in our health care system. Concerted leadership by the health care and technology industries as well as federal, state and local governments is needed to address a myriad of technical, administrative and other issues that would underlie a strong health information
technology marketplace. "Many of the agents and entities that are necessary for the health care
industry to realize better value do not exist and must be developed and made operational before widespread change can occur," the report says. President Bush's executive order and Secretary Thompson's summit meetings are aimed at bringing federal leadership to bear in order to bring the many stakeholders together to act. While the federal government is the nation's largest single provider and purchaser of health care, there has been "a previous lack of cohesive federal policies supporting" health information technology. In recent years, this problem has begun to be addressed, and the report summarizes current federal activities. Today's HHS report (as well as the reports of the Veterans Affairs and Defense Departments and the Office of Personnel Management) accelerates these efforts. For adoption of electronic health records in particular, the most commonly-cited barrier is insufficient resources and a perceived lack of evidence for a positive return on investment. Non-financial issues like training demands and changes in working practices are especially important. In addition, without product certification of EHR systems, smaller practices do not have the expertise to be confident about investing. And health insurance reimbursement policies may not encourage the efficiencies and improved care provided by EHRs -- while savings from these systems might benefit payors without being shared by the hospitals or physicians who make the EHR investment. The Health Information Technology Leadership Panel announced by Secretary Thompson today will be charged with assessing costs and benefits and making recommendations; and today's report identifies several potential policy options for incentivizing EHR adoption.
Framework for Action: Goals and Strategies
Secretary Thompson said today's report launches the Decade of Health Information Technology, an initiative with joint public-private leadership to obtain the benefits of health information technology for Americans. The report says that "the federal government will provide a vision and a strategic direction for a national interoperable health care system, but will rely on a competitive technology industry, privately operated support services, and shared investments …." The private sector must develop the market institutions to deliver the products and services. It can best ensure that health information technology products are implemented in ways that meet the varying needs of American health care across settings, cultures, and geographies. And only it can continue constant innovation and ensure that products are delivered on an affordable basis.
The report identifies four major collaborative goals. With these goals are 12 strategies for advancing and focusing future efforts:
Goal 1: Inform Clinical Practice. This goal centers
largely around efforts to bring EHRs directly into clinical
practice. Three strategies for realizing this goal are:
Strategy 1. Provide incentives for EHR adoption. The transition to safe, more
consumer-friendly and regionally integrated care delivery will
require shared investments in information tools and changes to
current clinical practice.
Strategy 2. Reduce risk of EHR investment.
Clinicians who purchase EHRs and who attempt to change their
clinical practices and office operations face a variety of risks
that make this decision unduly challenging. Low-cost support
systems that reduce risk, failure, and partial use of EHRs are needed.
Strategy 3. Promote EHR diffusion in rural and underserved
areas. Practices and hospitals in rural and other
underserved areas lag in EHR adoption. Technology transfer
and other support efforts are needed to ensure widespread adoption.
Goal 2: Interconnect Clinicians. Interconnecting
clinicians will allow information to be portable and to move with
consumers from one point of care to another. This will
require an interoperable infrastructure to help clinicians get
access to critical health care information when their clinical
and/or treatment decisions are being made. Three strategies
for realizing this goal are:
Strategy 1. Regional collaborations. Local oversight of health information exchange that reflects the
needs and goals of a population should be developed.
Strategy 2. Develop a national health information
network. A set of common intercommunication tools such as
mobile authentication, Web services architecture, and security technologies are needed to support
data movement that is inexpensive and secure. A national
health information network that can provide low-cost and secure
data movement is needed, along with a public-private oversight or
management function to ensure adherence to public policy
objectives.
Strategy 3. Coordinate federal health information
systems. There is a need for federal health information
systems to be interoperable and to exchange data so that federal
care delivery, reimbursement, and oversight are more efficient and
cost-effective. Federal health information systems will be
interoperable and consistent with the national health information
network.
Goal 3: Personalize Care. Consumer-centric information
helps individuals manage their own wellness and assists with their
personal health care decisions. Three strategies for
realizing this goal are:
Strategy 1. Encourage use of Personal Health Records.
Consumers are increasingly seeking information about their care as
a means of getting better control over their
health care experience, and PHRs that provide customized facts and
guidance to them are needed.
Strategy 2. Enhance informed consumer choice.
Consumers should have the ability to select clinicians and
institutions based on what they value and the information to guide
their choice, including the quality of care
providers deliver.
Strategy 3. Promote use of telehealth systems.
The use of telehealth -- remote communication technologies -- can
provide access to health services for consumers and clinicians in
rural and underserved areas.
Goal 4: Improve Population Health. Population health
improvement envisions improved capacity for public health
monitoring, quality of care measurement and bringing research
advances more quickly into medical practice. Three strategies
for realizing this goal are:
Strategy 1. Unify public health surveillance
architectures. An interoperable
public health surveillance system is needed that will allow
exchange of information, consistent with privacy laws, to better
protect against disease.
Strategy 2. Streamline quality and health status
monitoring. Many different
state and local organizations collect subsets of data for specific
purposes and use it in different ways. A streamlined
quality-monitoring infrastructure that will allow a complete look
at quality and other issues in real-time and at the point of care
is needed.
Strategy 3. Accelerate research and dissemination
of evidence. Information tools are needed that can
accelerate scientific discoveries and their translation into
clinically useful products, applications, and knowledge.
EHR Incentive Options to Be Reviewed
Looking in particular at EHRs and incentive options, the report
says HHS will examine many potential policy options for
incentivizing EHR adoption. The report says options to be
reviewed include:
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Regional grants and
contracts. HHS will further explore how
grants and contracts could be made available to regions,
states, or communities for EHR adoption and health information
exchange. Up to five state and regional demonstration
projects will be funded by HHS’ Agency for Healthcare
Research and Quality (AHRQ) in FY 2004, and funding would be
doubled under the President’s FY 2005 budget request to
$100 million.
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Update federal physician self-referral and anti-kickback
protections. The physician self-referral
prohibition and the anti-kickback statute provide important
protection against fraud and abuse. However, these statutes did
not anticipate interoperable health information technology that
necessarily involves relationships among different
providers. HHS could explore safe harbors or exceptions to
these laws that could accelerate EHR adoption without creating
inappropriate conflicts of interest or potential for abuse.
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Medicare reimbursement for use of
EHR. There are two general approaches being
explored to reimburse clinicians for the use of EHRs that are
consistent with current Medicare law. Under the physician
fee schedule, the Centers for Medicare & Medicaid Services
(CMS) could consider payment for specific EHR uses though the
use of new codes or modifiers based on the best estimate of the
incremental, amortized costs actually incurred by physicians
nationwide who use EHRs. Demonstration projects could test
alternative EHR payment methods, such as direct contracts with
physicians, and determine whether different incentives affect
adoption of different EHR functionality.
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Medicare
“pay-for-performance” demonstration
programs. Pay-for-performance would reward
clinicians for delivering the best quality of care, not the
highest volume of care. CMS, under its demonstration
authority, could carry out pay-for-performance demonstration
programs, above and beyond those planned as a part of
implementation of the Medicare Modernization Act passed last
year.
In order to better assess such options, Secretary Thompson is
convening a Health Information Technology Leadership Panel,
consisting of executives and leaders. This panel will assess
costs and benefits and will consider immediate steps for both the
public and private sector. The Health Information Technology
Leadership Panel will deliver a report to the Secretary by this
fall.
In addition, HHS and the Office of Personnel Management are
participating in the recently formed National Alliance for Health
Care Information Technology Advancement. The Alliance is comprised
of purchasers and payers representing almost 200 million covered
persons. It will work toward identifying financial and
non-financial incentives. HHS will work closely with the
Alliance during the next 90 days to identify specific strategic
actions to meet these goals.
Key Actions
Secretary Thompson announced a range of actions underway or soon to
be launched, which will advance the strategic elements of the
“Framework:”
Establishing a Health Information Technology Leadership Panel to
evaluate the urgency of investments and recommend immediate
actions -- Secretary Thompson will appoint the panel of
executives and leaders to assess the costs and benefits of health
information technology to industry and society, and develop options
for immediate steps by both the public and private sector, based on
their individual business experience. The Health Information
Technology Leadership Panel will deliver a report on these options
to the Secretary no later than fall 2004.
Private sector certification of health information technology
products -- EHRs and even specific components such as decision
support software are unique among clinical tools in that they do
not need to meet minimal standards to be used to deliver
care. To increase uptake of EHRs and reduce the risk of
product implementation failure, the federal government is exploring
ways to work with the private sector to develop minimal product
standards for EHR functionality, interoperability, and
security. A private sector ambulatory EHR certification task
force is determining the feasibility of certification of EHR
products based on functionality, security, and
interoperability.
Funding community health information exchange demonstrations
-- HHS’ Health Resources and Services Administration, with
the Foundation for eHealth Initiative, announced $2.3 million in
contracts to support the Connecting Communities for Better Health
Program. The program is providing seed funds to implement
health information exchanges, including the formation of regional
health information organizations.
Planning the formation of a private interoperability
consortium -- To begin the process of movement toward a
national health information network, HHS will issue a Request for
Information (RFI) this summer inviting responses describing the
requirements for private sector consortia that would form to plan,
develop, and operate a health information network. The role
that HHS could play in facilitating the work of the consortium and
assisting in identifying the services that the consortium would
provide will be explored, including the standards to which the
health information network would adhere in order to ensure that
public policy goals are executed and that rapid adoption of
interoperable EHRs is advanced.
Requiring standards to facilitate electronic prescribing --
CMS is accelerating publication of a regulation laying out the
first set of widely adopted e-prescribing standards in preparation
for the implementation of the new Medicare drug benefit in 2006.
When the final standards are adopted, Medicare Prescription Drug
Plan (PDP) Sponsors will be required to offer e-prescribing, which
will significantly drive adoption across the United States.
The proposed regulation will be published by CMS this year.
Establishing a Medicare beneficiary portal -- CMS will
develop a Medicare Beneficiary Portal, an immediate step in
improving consumer access to personal and customized health
information, providing secure health information via the
Internet. The portal will enable authorized beneficiaries to
have access to their Medicare information online or by calling
1-800-MEDICARE. Initially the portal will provide access to
fee-for-service claims information, which includes claims type,
dates of service, and procedures. The pilot test for the
portal will be conducted in Indiana, beginning this year. In
the near term, CMS plans to expand the portal to include prevention
information in the form of reminders to beneficiaries to schedule
their Medicare-covered preventive health care services. CMS
also plans to work toward providing additional electronic health
information tools to beneficiaries for their use in improving their
health.
Commitment to standards -- A key component of progress in
interoperable health information is the development of
interoperability standards and policies. HHS, DoD, and VA
have endorsed 20 sets of standards to make it easier for
information to be shared across agencies and to serve as a model
for the private sector. Additionally, the Public Health Information
Network (PHIN) and the National Electronic Disease Surveillance
System (NEDSS), under the leadership of the Centers for Disease
Control and Prevention (CDC), have made progress in development of
shared data models, data standards, and controlled vocabularies for
electronic laboratory reporting and health information
exchange. With HHS support, Health Level 7 (HL7) has also
created a functional model and standards for the EHR.
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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
Last Revised: July 21, 2004
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