Not everything about improving health care is breathlessly hanging on one high stakes decision.
The Supreme Court will rule soon enough on the constitutional challenges to the Affordable Care Act. Meanwhile, even amid the drama and bitter struggles, progress can occur in health care improvement—like the ever increasing adoption of health information technology. Believe it or not, there is broad agreement about using this technology in health care. Scott Gottlieb and J.D. Kleinke in a recent Wall Street Journal opinion said it well, “. . . promotion of health information technology is one of the only demilitarized zones in Washington—consistently attracting bipartisan support . . . .”
So, this rare consensus seems real and durable, but what is actually happening in the hallowed HIT ground where both sides have somewhat oddly come to a policy truce?
Since May of 2004 when President George W. Bush established the Office of the National Coordinator for Health Information Technology (ONC) we’ve witnessed a slow but relentless upturn in adoption. That progress dramatically accelerated with attention and funding in the American Reinvestment and Recovery Act in 2009. Since 2006, the Robert Wood Johnson Foundation (RWJF) in collaboration with ONC has supported an ongoing, independent effort to monitor the national adoption of the electronic health record.
RWJF recently released the latest edition of that report, “Health Information in the United States: Driving Toward Delivery System Change 2012”. Both Health Affairs and JAMAalso simultaneously published articles based on chapters in that report, and Health Affairs hosted a briefing at the National Press Club regarding that release. Much of the information in this report comes from two important national surveys—one on ambulatory care conducted by the CDC/NCHS and the other on inpatient care by the American Hospital Association. The RWJF project in collaboration with ONC developed the key definitions for both the “basic” and the “advanced” electronic health record. All of the legitimate assessments of the national rate of electronic health record adoption in the U.S. since 2006 have used these gold standard definitions.
From the most recent NCHS and AHA surveys included in the 2012 report—there is both good and sobering news. First the good—the rates of adoption at both the physician and hospital level are increasing significantly. For example, the rate of physician adoption of at least a “basic” electronic record rose from 12 percent in 2007 to 34 percent in 2011. Similarly, for hospitals—the adoption of at least a “basic” system has risen from about 9 percent in 2008 to about 26 percent in 2011. The sobering news comes with the next step.
Unfortunately, these same surveys highlight both increasing physician intention to apply for meaningful use incentives but also an extremely limited ability to use the technology meaningfully. For example, a little over one half of physicians reported an intention to apply for incentive payments while only 10.5 percent of those actually had an electronic record with functionalities to support meaningful use. For hospitals, over 80 percent at the time of this survey could not meet meaningful use standards.
What about exchanging the information? That step remains a major challenge. In this year’s report immediate past national coordinator, David Blumenthal notes, “The exchange of information is going to be one of the most ambitious health care social projects that we have ever undertaken. The mapping of the human genome will look simple in comparison. The reason is that it’s a human-ware problem, not a software problem.”
RWJF has had its own experience with health information exchange challenges. Central Indiana Alliance for Health started as one of 17 communities in RWJF’s long term effort to help communities improve care, Aligning Forces for Quality. In Aligning Forces, regional leaders work together on a variety of activities—including publicly reporting quality and cost information, engaging consumers, changing payment and supporting clinical improvement. Central Indiana with its nation leading Indiana Health Information Exchange (IHIE) should have been ideal for such an effort. Unfortunately, they weren’t. As noted in this report, these leaders were simply not able to use the information exchange resource for Aligning Forces—especially for public reporting of quality measures for their community. IHIE’s problems were not technical ones—but cultural—or human-ware problems. The community leaders could not overcome longstanding resistance to using their information exchange for publicly available information.
We have many tough health and health care challenges facing our nation—and we have just a few areas of consensus where we’re working together. As this RWJF report shows, we are making some progress in the HIT sweet spot—but just having consensus is not going to be enough. If we are to meet our massive challenges, we will need all hands and minds working together to meet them—and even then, there are no guarantees. Time is ticking, friends—let’s stay focused—and look hard for more DMZs. We’re going to need them.
Michael W. Painter, JD, MD is the senior program officer at the Robert Wood Johnson Foundation.