Electronic health records seen as more complex than first thought

In his state of the union address in April 2004, President George W. Bush called for most Americans to have interoperable electronic health records (EHRs) within 10 years. More than a year after that ambitious pronouncement, business leaders, IT executives, healthcare professionals and average consumers are still debating exactly how that will happen.

"There was a wave of euphoria when all of this was recognized as a major national issue," said Scott Wallace, president and CEO of the Chicago-based National Alliance for Health Information Technology. "People who had been working on this for 20 years said, 'Finally!' and others went from not paying attention to thinking, 'this is important.' But now we've moved into a phase where people are realizing just how complicated and complex the issue really is."

The vision espoused by the president is to create an electronic health record-alternately referred to as an electronic medical record (EMR) and electronic patient record (EPR)-that will track a person's health information over time as he or she receives care from different providers in different settings.

"Health care lags behind pretty much every other U.S. industry in the adoption of IT," notes Mark Leavitt, MD, chairman of the Certification Commission for Health Care Information Technology and chief medical officer for the Health Information and Management Systems Society (HIMSS). "As a percent of revenues the healthcare industry spends 3% to 4% or less. By comparison the financial services industry spends about 12%."

FIRST STEPS

If the nation took its first step on this journey of a thousand miles with the 2004 State of the Union address, it sprinted the next 200 yards. Following the speech, the administration created the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services. National Coordinator for HIT David Brailer, MD, quickly outlined his intent to create a system that would:

Because achieving those goals requires highly technical work on a number of interrelated fronts, HHS in June issued four requests for proposals. Contractors were solicited to develop prototypes for unifying and harmonizing health IT standards; develop a certification process for EHRs and related interoperability systems; assess privacy issues and suggest possible solutions; and develop prototypes for an Internet-based national health information exchange. HHS anticipates awarding contracts for the first three requirements at the end of this month.

PRIVATE INVESTMENT

While the federal government is creating a framework for exploring healthcare IT, the private sector will have to flesh out most of the details. Although the president requested that $125 million in the 2006 budget earmarked for healthcare IT, that amounts to little more than seed money for the massive initiative.

"I believe the federal activity is a catalyst," says the Certification Commission's Leavitt. Although the federal funding is welcome, its purpose is to stimulate private investment, rather than bankroll the initiative.

To further encourage private-sector ownership in the movement, HHS in June formed the American Health Information Community, a 17-member collaborative with numerous private-sector representatives that will serve much like a board of directors to advance the movement over the next two to five years.

To date, private groups have largely welcomed the government's limited role in advancing EHR and are themselves stepping forward with their own contributions. For example, the California HealthCare Foundation, an independent philanthropic organization committed to improving California's healthcare delivery and financing systems, in June awarded the Certification Commission for Healthcare Information Technology a $219,000 grant to further its work in developing a national certification process for EHRs.