Health IT Gains Momentum

Key Points

NATIONAL REPORTS-Only a few months ago, efforts to build a national electronic health information system appeared dead in the water. Now there is growing support on Capitol Hill for legislative action, plus strong statements from the Bush administration backing health information technology (HIT).

Healthcare is moving toward an IT tipping point, says Robert Kolodner, National HIT coordinator in the Department of Health and Human Services (HHS). He points to progress by the American Health Information Community (AHIC) in coordinating policies for health privacy and security and in establishing interoperable standards to support a national HIT system. AHIC seeks incentives for physicians and pharmacies to use certified e-health record systems. And Medicare is encouraging e-health use among small and medium-size physician practices through a demonstration project that offers bonuses to providers.

Health plans, employers, patient groups and consumers have formed the Health IT Now coalition to press for legislation strengthening federal involvement in this area. A main goal is for Congress to enact bills pending in the House and Senate that support IT standards and encourage certification of hardware and software that fits the emerging system. However, physicians have objected to a provision establishing a doctor-rating system based on federal claims data. The American Medical Assn. and other medical groups prefer to base any such evaluations on claims data, which the doctors believe better adjusts for patient risk factors and would yield more accurate ratings.

Meanwhile, support is growing for requiring increased use of electronic prescribing systems as one way to spur HIT adoption. This technology promises to reduce costs, as well as curb medication errors and enhance patient safety. E-prescribing network provider SureScripts reports that 35 million scripts were transmitted electronically in 2007, up from 13 million in 2006, and under 1 million in 2004. However, this represents only 2% of about 1.5 billion prescriptions written each year. More than 30,000 physicians now actively e-prescribe, but that is less than 10% of all doctors.

To move forward, Sen. John Kerry (D-Mass) and a bi-partisan group of senators have proposed legislation requiring physicians to transmit prescriptions electronically by 2011 or face reduced payments from Medicare. Physicians would receive grants to cover some e-prescribing implementation costs as well as bonuses for going electronic. Consumer groups and pharmacy benefit managers (PBMs) back this approach, as does the Bush administration. HHS Secretary Mike Leavitt recently urged Congress to include an e-prescribing mandate for physicians in Medicare legislation to rescind the planned 10% cut in Medicare payments to doctors.

Even without a legislative mandate, the Centers for Medicare and Medicaid Services (CMS) is encouraging e-prescribing by establishing standards to support a voluntary e-prescribing system for Medicare Part D, as required by the Medicare Modernization Act. CMS has tested basic and added standards; the next step is to finalize policies for communicating plan formulary coverage information and patient medication history to providers at the point of care.

One hurdle to e-prescribing is the current law requiring paper prescriptions for controlled substances. Law enforcement officials are supposed to develop rules permitting e-prescribing of these drugs, but have been slow to act for fear that electronic prescribing would allow drug dealers and other parties to hack into the system to obtain painkillers and other drugs.

Pharmacists and providers counter that the paper-based prescribing system is just as vulnerable to abuse, and physicians don't want to deal with paper and electronic systems simultaneously. System operators are expanding e-prescribing systems so that physician can also access lab test information and patient medication records. These and other advances should further spur health IT implementation.