On Dec. 6, President-elect Obama announced the
three major pillars of his economic recovery plan: rebuild our
roads/bridges, enhance our schools including broadband, and deploy
electronic health records for every clinician and hospital in the U.S.
I can summarize all my advice to the new administration in one sentence: Allocate
Federal funds of $50,000 per clinician to states, which will be held
accountable (use it or lose it) for rapid, successful implementation of
interoperable CCHIT certified electronic records with built in decision
support, clinical data exchange, and quality reporting.
will this improve care coordination which will lead to better
health care value (reduced cost, enhanced quality), it will create jobs.
Just how many jobs would this create? For just the Beth Israel Deaconess Community Clinician project, here’s the list of jobs we created:
2009, we will implement 150 physicians in 75 practices, or 13
physicians in 6 practices per month. The direct staff we’ll need are:
Massachusetts eHealth Collaborative: 6 FTEs (5 practice consultants plus a project manager)
Concordant: 9 FTEs (5 on-site assessment/design/deployment/support, 2 technical lead/system architect, 2 project management)
eClinicalWorks: 4 FTEs (3 on-site trainers, plus part of a product specialist and a project manager)
At BIDMC, the project is run by 3 FTEs (Project Director, Technical Lead, Senior Practice Consultant)
we’ve created 22 jobs for the rollout and support of our EHR project.
Multiply this by the number of clinicians needing EHRs in the country
and you’ll see that the Obama plan will create tens of thousands of new
high tech jobs.
When I’ve discussed the Obama Economic plan with
my colleagues, some have said that it’s too early to invest in EHRs
because they are not yet standards-based or fully interoperable. I
believe that commercial EHRs are good enough and as of 2008, we have
many real examples of data sharing. Here are the statistics from our
work in Massachusetts that includes homegrown EHRs, eClinicalWorks, GE
Centricity, Next Gen, Allscripts/Misys, and Epic.
NEHEN – In
2008, we’ve done 60 million data exchange transactions a year from
EHRs, practices management systems, and hospital information systems.
– We’ve done half a million e-prescribing transactions among providers,
payers and pharmacies. Every discharge from the hospital and emergency
department at BIDMC generates a standards-based clinical summary which
is sent electronically to PCPs and referring clinicians. In 2009, we’ll
expand this to include referral workflow, community to community
exchange, and several additional hospitals including Children’s.
eHealth Collaborative – We’ve wired three communities (Brockton,
Newburyport, North Adams) with roughly 500,000 patients, 597 physicians
in 142 practices in 192 sites, and 4 hospitals including hospital-based
laboratories and imaging centers. North Adams went live in May 2007,
Newburyport went live in September 2008, and Brockton is 40% complete.
Data exchange includes problem lists, procedures, allergies,
medications, demographics, smoking status, diagnoses, lab results and
radiology results. Standards used include HL7 2.6, Continuity of Care
Record/Document, NCPDP Script 8.1, LOINC, CPT4, ICD9, and RxNorm. Over
90% of patients have opted in for community data sharing. Over 300,000
records have been exchanged, all from existing commercial EHRs.
Thus, the EHRs are ready, the standards are harmonized, the architecture is
designed, and the only barrier is political. The Obama commitment to a
nationwide EHR implementation effort means that 2009 is the tipping
point. Let us band together, payer, provider, employer and patient, to
make it happen!
See also: I’ve written several recent blogs about the cost of electronic health records, the state of interoperability, and my predictions for the early healthcare IT activities of the Obama administration.
John D. Halamka, MD, MS, is CIO of the
CareGroup Health System, CIO and Dean for
Technology at Harvard Medical School, Chairman of the New England
Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US
Healthcare Information Technology Standards Panel (HITSP), and a
practicing emergency physician. He blogs regularly at Life as a Healthcare CEO, where this post first appeared.