HIT: Can we learn from others’ mistakes?

August 27, 2009

Recently the White House announced that the first chunk of money, $1.2 billion in grants, is set to prime the healthcare IT initiative in the U.S. The funds will begin flowing sometime next year. About half will go to establish HIT centers that will help hospitals and docs to build their own electronic medical records (EMRs). The other half will go toward developing a nationwide system of EMRs.

Recently the White House announced that the first chunk of money, $1.2 billion in grants, is set to prime the healthcare IT initiative in the U.S. The funds will begin flowing sometime next year. About half will go to establish HIT centers that will help hospitals and docs to build their own electronic medical records (EMRs). The other half will go toward developing a nationwide system of EMRs.

Ironically, as the Feds wiggle this cornerstone of a national HIT system into place, the one in Britain is crumbling. Seven years after U.K. prime minister Tony Blair announced that English doctors within a decade would be able to share records, conservative politicians there are talking about pulling the plug on what they see as a terminally ill system, one that has not met its goals and shows no sign of being able to do so.

Parallels between this snake-bit program and our own are a little disconcerting. Like the one in the U.K., the U.S. initiative to digitize patient records is coming from the top down rather than the bottom up and it has tight deadlines. The White House-driven initiative will begin implementation already next year, wagging a carrot in the form of front-loaded reimbursement initiatives. After five years, the carrot turns to stick, as penalties come into effect for providers who haven't jumped onboard.

In some ways, the U.S. goals are loftier than those in Britain. The U.K. initiative had a much longer ramp-up: from 2002 to 2010. Also, it was to be spread over a smaller population: about 60 million versus 300 million. Where the U.S. plan has an advantage is in its goal. Rather than creating a centralized, national medical records system, the U.S. plan seeks to improve the efficiency of healthcare. Specific milestones will come from a still-evolving definition of "meaningful use," one that bureaucrats and providers are trying to scale up over the five-year period of adoption.

Also working to the advantage of the proposed U.S. initiative is a much more evolved IT infrastructure. When the U.K. program began, vendors had neither the technology nor the expertise to meet its ambitious goals. Things have changed since then. Best-of-breed IT systems continue to flourish, but they have become more comprehensive, spanning entire healthcare enterprises. The expertise to run these systems is beginning to develop as well. Earmarking grants for what will likely serve as HIT "centers of excellence" to serve as examples of how the technology can be successfully applied will add to this expertise. These centers may also serve as places where staff from other facilities can be trained before they jump into their own EMR systems.

Not yet addressed, however, is how the many currently operating HIT pieces, such as RIS and PACS, will be leveraged. To ignore them in the sculpting of a comprehensive EMR would be disastrous, as it would leave out critically important parts of the diagnostic process. And even if the decision to involve them in broad-based EMRs is made, there is no certainty that available interfaces will be up to the task.

What may decide the success or failure of the Obama HIT initiative is whether providers wholeheartedly embrace the concept and technology behind the systems that promise to make medical practice more efficient. There will be problems-very likely many problems-that in the short-run will slow rather than speed healthcare. These problems will have to be worked through by dedicated staff.

The last time this country had such an ambitious public plan built around technology was 40 years ago. Let's hope we have more follow-through in medical records than we've had in outer space.