HEALTH IT: Investment, Innovation and Implementation

With the President's promise to pledge $19 billion to health information technology, both doctors and hospitals are looking ahead with hope, and some wariness, at the adoption of HIT on their home turf.

Part of Obama's strategy in successfully implementing health IT has been to appoint Dr. David Blumenthal, a Harvard Medical School practicing physician, professor, and policy director for Massachusetts General Hospital, as "National Coordinator for Health Information Technology." Dr. Blumenthal's experience and expertise in so many different areas of health care has made him a trusted facilitator of the implementation of health information technology. In a series of essays about Health Information Technology, Dr. Blumenthal writes that there is a growing consensus that "wiring the health care system is fundamental to enhancing quality and containing cost—and thus improving overall system efficiency," and the government should play a role in helping HIT attain its full potential.

Two upcoming articles from the New England Journal of Medicine have studied the application of health information technology today, and have come out with some important points for HIT proponents to keep in mind as care providers prepare to take the plunge into electronic records and broader health IT initiatives.

First, according to a study conducted by the Robert Wood Johnson Foundation, only about nine percent of hospitals nationwide actually keep electronic medical records, far below previous estimates. "We have a long way to go," article author Dr. Ashish K. Jha, a Harvard School of Public Health professor, told the New York Times.  The study did not ask any of the 3,000 hospitals surveyed if they actually applied HIT to fulfill the goals outlined by the Obama Administration and Congress, such as improving quality of care, patient safety, and effective communication. Dr. Blumenthal suggests that the government can encourage caregivers to make greater use of health IT by offering grants to physicians and hospitals that need financial help to start health IT programs, investing in community-based health IT support networks, and using financial incentives to encourage the adoption of HIT.

Second, Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane from the Children's Hospital in Boston warn that the current electronic recordkeeping systems offered to hospitals are old, pre-internet era software platforms. Pouring huge amounts of government funding into these older programs will be a costly policy mistake. Instead, they urge the government to stimulate and "referee" the development of new "open" software platforms, citing Apple's innovative iPhone application as an example.

In his essays, Dr. Blumenthal suggests the government should encourage the creation of a review board to oversee the quality of HIT programs and make sure there are standards of data interoperability to facilitate effective communication between care providers. He counters the argument advanced by experts like Mandl and Kohane by suggesting that funding software developers to come up with an ideal system of recordkeeping, rather than funding the adoption of health IT now is "letting the perfect be the enemy of the good." Dr. Blumenthal argues that if we wait to adopt health IT,

[W]e will sacrifice important opportunities to save money and improve quality of care... if we change incentives in our payment system to reward quality and efficiency, doctors and hospitals will demand improved and more capable systems from vendors.

As we have said before, health IT isn't intended just to ditch outdated paper systems of record keeping, the object of the game is to improve the delivery of health care. The application of health IT is an essential part of health reform, and has a huge potential to improve the quality, safety, and efficiency of our health system. Even in the face of reasonable warnings about HIT, with Dr. Blumenthal at the helm of its implementation, the future of health IT looks bright.