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HEALTH IT: An Investment Worth Making

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say on Health Information Technology.

Health Information Technology (HIT) is infrastructure just like roads and bridges. We have neglected to invest in both for far too long. The impediments to HIT spending are formidable—doctors are reluctant to take the time to adopt HIT, we lack the ability (but not the technology) to exchange data, and privacy concerns still threaten to derail legislation. Yet, we are now in a position to overcome them. A few successful public and private HIT programs are creating a greater awareness of what HIT can accomplish and we now have the political leadership necessary to disseminate these models and recreate their success across the country.

So, what are our first steps? To lay the foundation for utilizing health information technology, I recommend the following:

  1. Make broadband access in rural areas possible ASAP.
  2. Announce that we are moving to electronic medical records and that additional privacy protections will be implemented simultaneously, including mandatory notification of breaches by HIPAA-covered entities and vendors of Personal Health Records, and strengthening HIPAA's rules on marketing and business associates' use of Protected Health Information.
  3. Offer time-limited incentive payments for purchasing and implementing health IT systems / software packages that meet certain functional requirements (e.g., interoperability), privacy protections, and are designed to achieve quality of care improvement goals (e.g., point-of-service decision support tools, managing chronic conditions). A certifying entity like CCHIT should be charged with blessing these systems.
  4. Offer incentives to providers who acquire a new and approved electronic records system that includes decision support. Incentives could take the form of grants, partial loan forgiveness for primary care clinicians, etc. and could be awarded in reverse proportion to provider group size (the smaller the group, the more money per doctor). Incentives should include support for skilled personnel to train clinicians and staff in use of electronic information system, convert paper records, and eventually to help maintain electronic records systems. A timeframe should also be established whereby physicians must have an HIT system operational to continue to receive Medicare payments.
  5. Reward states that are utilizing HIT systems to control their Medicaid costs and improve care (e.g., chronic care management that has both medical and behavioral care components), and provide additional incentives for states that move their state employees into a similar system.
  6. Offer grants to states or regions that organize and operate health information exchanges to offer private, secure access to the new data.
  7. Create and fund webinar and conference presentations by physicians from those who have successfully implemented HIT systems (e.g., Kaiser Permanente, the VA, and the Billings Clinic) to teach the country's reticent physicians that HIT is a good thing. Provide financial incentives (e.g., free CME credit) to encourage physician attendance.

Much like roads and bridges, interoperable HIT is necessary to make all other aspects of a quality, affordable health system possible. Bringing 21st century information tools to our health system is an investment worth making, but it is also an investment that will take some time to fully mature. We cannot restore the health of our economy without fixing our health care system, and we cannot fix our health system without bold initiatives to encourage HIT