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TECHNOLOGY: Singing From the Same Hymnal


You remember the eight-track versus cassette tape debate? Or VHS versus betamax? Well, the electronic health records world is having its own debate, behind the scenes, over technology standards. How will it all shake out - and how does it affect you?

Family physician Michael Poss is frustrated.

Last spring, his four-doctor, Carrollton, Ga., practice spent $150,000 on an electronic health records (EHR) system, hoping to both streamline operations within the practice and allow seamless communication with the labs, hospitals, pharmacies, and other doctors the practice has a relationship with. The hope: that they’d be able to send patient information, lab reports, and prescription information back and forth in real time, speeding up efficiency, improving patient care, and increasing their return on investment.

There was one big glitch, though. None of those labs, hospitals, pharmacies, and other doctors were using EHR systems that were set up to interact with each other, which made such trading of information, well, impossible. Poss’s practice had the tools - and so did a few of the providers he works with - but the systems did not speak a common language.

“For the hospitals, it’s not a priority,” says Poss. “And the pharmacies are just starting to get savvy. Meantime, we’re ready to go. And we’re tired of shuffling faxes.”

Turns out Poss and his partners, when they installed their EHR, were hoping more for a best-case scenario than reality.

Still, if several government panels and private-sector groups have their way, it won’t be too long until that best-case scenario - a free flow of medical information among all providers, and even payers and consumers - is upon us.

When President Bush brought computerized medical records front and center for the public by mentioning them in two subsequent State of the Union addresses, he started a flurry of activity on the EHR standardization and interoperability front. Then, in 2004, he called for 50 percent of the healthcare industry to go digital within 10 years, appointing a physician as head of the Office of the National Coordinator for Health Information Technology (ONCHET), under the Department of Health and Human Services (HHS).

ONCHET's initial big push? Creating EHR interoperability standards, starting with IT products marketed to the physician’s practice.

In November, ONCHET awarded $18.6 million to four IT heavyweights - Accenture, Computer Science Corporation (CSC), IBM, and Northrop Grumman - to develop prototypes for an interoperable, standards-based network for exchanging healthcare information. Once created - it’s supposed to take a year - the designs will be placed in the public domain so others can use them to stimulate ideas.

Meanwhile, three healthcare IT industry associations have joined forces to launch The Certification Commission for Healthcare Information Technology (CCHIT). They also aim to get health IT products singing from the same hymnal. But this industry group has a second important mission: to develop a seal of approval for EHR systems that adhere to a set of standards (functionality, security, reliability and interoperability), thus reducing financial risk to providers who are fearful of investing in various EHRs. CCHIT’s first list of certified EHR systems is due out in March.

“We’ll be looking at everything a physician would want in terms of being able to extract or send info to other clinicians - meds, labs, immunizations, clinical documentation, administrative and financial data,” explains Robert Tennant, senior policy advisor in health informatics for the Medical Group Management Association (MGMA) and a member of the CCHIT board.

There’s action at the state level, too. For instance, a group in Indiana, under a federal contract, is working to develop a prototype for a national IT infrastructure for the exchange of health information. It’s based on a mature EHR already used by 3,000 doctors and 18 hospitals in Indianapolis.

What’s all this mean to you? Well, simply put, these bodies are attempting to cook up the perfect interoperable system for physicians and hospitals nationwide, explains Karen Bell, a former Boston internist and current acting director of health information technology adoption with ONCHET.

“In the end, when we are done, physicians will have literally every bit of information at their fingertips to respond to a patient in need - whether that patient is in front of them, on the phone, or corresponding by e-mail,” predicts Bell.

Why all the fuss now? Money, mostly. A Rand Study published last fall showed that government and industry could save $41.8 billion to $77.4 billion annually if 90 percent of the healthcare industry adopted an integrated healthcare IT system. For office-based physicians, said the researchers, reaching 90 percent adoption would cost $17.2 billion, or about $1.1 billion a year.

That’s a lot of money, but Bell says that ONCHET, in scrutinizing existing EHRs and coming up with standards to which all EHRs will soon have to adhere, is working hard to make sure that systems that get the group's green light are “available at the lowest possible cost and that the funder of the system [the physician] derives the most benefit.”

Another study last year by a Boston-based nonprofit healthcare IT research group showed that a fully standardized EHR system shared by providers, labs, radiology centers, pharmacies, payers, and public health departments could yield a net value of $77.8 billion per year in reduced costs for providers and the government. That’s 5 percent of all U.S. healthcare expenditures.

With that much money to be saved, employers are naturally involved in the push too, says Tennant. Ford and GM recently released numbers showing that for each new car their plants produce, they must pay $1,500 to $2,000 in healthcare costs for employees. Knowing that adoption of healthcare IT can reduce costs, many employers like Ford and GM are pushing payers to offer financial incentives to doctors for healthcare IT adoption, says Tennant. However, such incentive programs won’t truly be meaningful until there’s standardization across systems. Thus, the existence of ONCHET.

Consumers are starting to push IT adoption among their physicians, too. In Boston, where Bell used to practice, a great many doctors have EHRs. When encountering a physician who doesn’t, lots of patients nowadays will leave the practice and keep looking until they find a doctor who does, says Bell. That’s how used to quick lab results and computer-generated care reminders they’ve become.

And yet, EHR adoption numbers are still low among doctors. Between 9 percent and 16 percent of physicians’ offices have an EHR system; less than 1 percent of practices are paperless. According to Tennant, some physicians fear the digital age, while still others worry they’ll pick the wrong program and spend way too much money on it. Others worry that the return on investment of EHR systems is as yet unproven.

But many healthcare IT providers disagree with that.

Justin Barnes, vice president of marketing and government affairs for healthcare IT company Greenway Medical Technologies, says his firm has been able to help its physician practice clients realize an average of between $22,000 and $80,000 return on investment annually by implementing and maintaining EHRs - even without full interoperability between multiple providers. And then there are the extreme cases. Barnes points to a five-doctor gynecology practice in upstate New York, which his company helped achieve a whopping $407,000 return on investment in one year.

The good news, says Barnes, is that despite all the ruckus and upheaval about interoperability and standards, physicians won’t even need to make any changes in what they do - besides sticking with or picking a quality IT vendor.

“There will be no extra work on the practice’s shoulders,” Barnes says. “It will be completely up to vendors like us to get on board with the new standards.”

That being the case, Bell emphasizes that it’s important for physicians who already have an EHR to contact their vendor and ask the following questions:

  • Are you are aware of the certification commission’s new criteria?

  • Did your product meet the criteria?

  • If not, what are your plans for meeting the new criteria in the future?

Says Bell, products already in the market that aren’t up to snuff will need to morph to satisfy the new criteria, which can only be good for physicians. Those that don’t morph will likely end up leaving the market. And if your practice doesn’t yet have an EHR, now is an excellent time to invest, since the government has become involved in making sure the healthcare IT products out there satisfy basic criteria for doctors and are poised to evolve as standards emerge for industry-wide communication.

Still not feeling comfortable investing all that money when interoperability standards haven’t even been set? Bell insists interoperability is close. It’s anybody’s guess as to exactly when all EHRs will interface seamlessly and all patient information - no matter who generates it - is at your fingertips wherever you are. But, Bell says, over the next two to three years, we will definitely see dramatically positive changes in how information flows through healthcare IT systems.

“The tipping point is near,” she says.

Suz Redfearn is a freelance writer and editor with more than 10 years of experience writing about business and healthcare issues. She can be reached via editor@physicianspractice.com.

This article originally appeared in the February 2006 issue of Physicians Practice.

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