Where were you?



I distinctly remember the first time I heard the title, “National Coordinator for Health Information  Technology”.  It was 2004.  That’s, of course, the year that RAND released its important national report card highlighting the overall mediocre state of health care quality.  You know the one that told us “it’s a flip of a coin.”  I was an RWJF Health Policy Fellow working on the Hill with then Majority Leader Bill Frist’s health policy staff.

There was a flurry of staff activity regarding the president’s pending executive order pushing adoption of the electronic health record and creating a new federal health information technology, dare I say, czar. . . . But what to call this new position?  To be honest, when I initially heard folks say the words, “national coordinator for health information technology,” my first thought was, “Well, that’s a mouthful.”  My second was “It sort of sounds like a character from that TV show, ‘The Love Boat’”.  But I kept those smart remarks to myself and quite quickly got on board—and, to be honest, never looked back.

At RWJF in 2005, several of us worked with then National Coordinator, Dr. David Brailer, on a partnership effort between the Office of the National Coordinator and RWJF.  With this project we extended a grant to Dr. David Blumenthal, then in Boston, to create a series of national reports that would track the national adoption of the electronic health record over several years as the nation progressed toward wider and wider adoption.  This week we’re issuing our third report in that series.Of course, the news is sobering.  This third report highlights yet again that overall adoption of the electronic record is stubbornly, almost shockingly, low in virtually all clinical settings.  This current report also highlights that without focused attention adoption of electronic health records might make disparities even worse.  Terrific.

The context is, however, different this time.  This report will be the first that we’ve issued with the nation on the cusp of a potential rapid acceleration of EHR adoption driven by the American Recovery and Reinvestment Act HITECH incentives.  With any luck, these federal incentives will help spark a rapid drive toward widespread meaningful use of the electronic health record.

Let’s be serious, though.  The stakes are pretty high now.  Big money is on the line—billions and billions of dollars.  The nation is watching.  And the problems continue to mount.  Health care costs continue to increase persistently.  Projections of the federal government’s obligations for Medicare and Medicaid, before any attempt to cover the millions of uninsured, escalate astronomically into the future.  Rather than receiving accolades for being a “high performing” industry well worth the enormous national expense, health care is encumbered instead with labels like “fragmented” or “dysfunctional” or “unsafe”.

So our search for ways to move health care from that fragmentation and dysfunction is pretty darn urgent.  As we search for the fix, most also agree that information about the quality and cost of health care is central to almost every viable potential solution.  In fact, adopting a bunch of electronic health records, while neat, will be meaningless—if that new, huge investment doesn’t generate the meaningful information to help us out of these fairly terrifying problems—that is, help us understand and target the persistent quality and exploding cost problems.

Unfortunately, we do not yet have that information.  We don’t.  We’re getting better, but we don’t have ideal measures or ways of reporting those measures to the people who need them.   And by “people”, I mean the health professionals, and, well, us—the public.   We are, however, getting much, much better at understanding what we need to do to create that great information.So, we’re at an important point on our journey.  Widespread, meaningfully applied health information technology could be the necessary accelerator for quality measurement and reporting—or at least we all hope it will.  As we highlight in our report, we will know soon enough if this combination of hope, urgent need, innovation and technology will be the spark we need.  If it is—if that happens—then in the next few years we will look back at this moment as the beginning of that acceleration. Like I now remember where I was when I first heard, “ONCHIT”, we’ll remember 2009 as that moment when widely available, helpful public information about health care cost and quality really began to move health care from fragmentation and dysfunction onto a path of sustainable high value.  Just in case, you might want to look around and remember since your kids or grandkids in a few years may ask, “Where were you?”

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4 replies »

  1. If this “government” run health care jacks up my premiums and costs me more in the long run…well, then i voted for the wrong guy again. just gonna quit. obviously obamanomics aren’t working out…got laid off in october, sent out 65 resumes to people in my industry, was told by the head of a decent company, that perhaps i should take a job repairing cars, because the economy sucks…what about us??? those that ARE responsible??? washington is not like it used to be…a bunch of pansies now…have a happy non committal holiday…fags.

  2. I believe that technology will totally assist in health care quality improvements in the very near future.
    It could cut down the queus for operations.

  3. Interesting tidbit on healthcare regarding “uninsured Americans” : of the 46 Million uninsured, 18 Million make more than $50,000 a year (about 7k over median income) and choose not to buy insurance. Of the 28 Million remaining, over 9.5 Million aren’t american citizens i.e. temporary workers or foreign exchange students. so the real number is closer to 18 Million americans, who make less than $50,000. interesting stat mainstream media doesn’t tend to look into very much.
    http://www.census.gov/prod/2009pubs/p60-236.pdf pag 28

  4. I agree that technology will eventually assist in health care quality improvements. However, it seems to me that we need to differentiate between the two proposed contributions to such improvements.
    On one hand, it is being suggested that the mere adoption of technology and its application to such meaningful tasks as CPOE, med lists, documentation, etc. will somehow improve quality of care. The RWJF paper quoted here makes cursory note of this and quotes several supporting articles. I would like to remind the authors that there has been also substantial enough evidence to the contrary, substantial enough to prompt Senator Grassley to inquire into the adverse effects of EHR technology.
    The only measurable data provided regarding quality improvements is the correlation of slightly better quality in safety net hospitals that adopted EHRs versus the ones that did not. However, it is not clear whether the better quality followed the EHR adoption, or the EHR presence is a result of better initial commitment to quality in those particular institutions.
    The second effort at quality improvement is in the form of reporting various measures to CMS or HHS. This is a very large subject and the Michael is covering it very well. Without going into the details of how to devise such measures in order to make meaningful progress, it stands to reason that we cannot even discuss quality unless we are able to somehow quantify it. So, I do agree that some form of quality reporting
    is absolutely necessary.
    I don’t see an absolute necessity to have these two efforts combined. Adoption of EHR has been dismal since their advent and now there are questions being raised regarding possible adverse effects. If we make EHRs a prerequisite to quality reporting, we may very well be slowing reporting efforts down.
    One option would be for HHS to publish its reporting requirements, just like CMS did with PQRI, and leave the implementation to technology companies and providers. I am certain they will find a way to comply, if proper incentives are in place, with or without EHRs.