We get all fired up about investing in health care reform — like the $19 billion + in stimulus funds we're pouring into Health Information Technology. Apparently, we are not the only ones. More than 300 people showed up at a recent Health Affairs briefing on Stimulating Health IT, featuring some of the contributors to the journal's March/April 2009 edition, which was dedicated to Health IT success stories and policy issues.

Everyone of course recognized that the stimulus money is a huge opportunity. The question is: How do we do HIT right? And what does "right" mean for the health care system, for patients, and providers?

"We are the generation that is going to completely automate and change the medium in which medicine and health are handled in this country. This is the equivalent of the land rush in the West. Everyone is suddenly an expert on health IT. We are going to waste that investment if we don't define what it is that we are going to get from this," said Neal Patterson of Cerner Corp, a leading health IT company.

We heard from some pioneers who are doing HIT right.

Louise Liang of Kaiser Permanente touted the success of Kaiser's EHR "KP HealthConnect," saying that it decreased office visits and increased nontraditional, patient-centered ways of provider care (e.g., phone calls and e-mails). Primary care visits decreased by 25 percent, specialty care dropped 21 percent, secure messaging went up. Patients are satisfied and care got more efficient.

Farzad Mostashari of the New York City Department of Health talked about the city's Primary Care Information Project (PCIP). This program is attempting to move the 29 community health centers in NYC (they serve half a million New Yorkers who are mostly on Medicaid or uninsured) onto EHRs by the end of 2009. Farzad was candid about how PCIP was an uphill battle and required a major cultural change in most practices. But uphill isn't a synonym for insurmountable. According to a recent New York Times article, Mostashari's program has already led to IT adoption by more than 1,000 physicians, in outpatient clinics, community health centers, small group practices, even one jail.

(BTW we blogged a few days ago about CHCs, including some using computerized patient records.)  

Industry representatives talked about how the provisions in the stimulus bill (not just the money) can help us finally overcome some of the barriers to widespread IT adoption and to change the business model. As Colin Evans of Dossia noted, we've been asking a lot of the wrong questions about Health IT. We should be asking, "How do we get the right data to individuals?" (We think he meant both individual patients and individual providers).

Google's Alfred Spector noted that the stimulus provisions will help us break down some of the barriers. For instance, we do not have enough data in electronic form. The stimulus will change that. One of the provisions of the stimulus requires HIPAA Covered Entities (e.g., clinics, hospitals, physician practices, health plans) to provide patients with electronic copies of their records, not a paper copy, as early as February 2010. The stimulus will also go a long way to break down some of the data silos and expand data exchange, which can become an important tool for quality, outcome, comparative effectiveness and public health research. It also mandates that work begin on uniform standards and nationwide interoperability.

And the second you talk about electronic copies of records and interoperability, you have to talk about... privacy. Deven McGraw of the Center for Democracy and Technology did her usual even-keeled presentation of how all of this should not detrimentally affect the privacy rights of patients. Of course, the digitization of personal health information poses risks to privacy, but the economic stimulus legislation went a long way to afford additional privacy protections. For instance, there are new limits and consent requirements on the marketing and selling of health data; enforcement of existing protections are bolstered, and both HIPAA Covered Entities and vendors of personal health record systems must now notify affected individuals whenever there is a security breach involving their health information.

Of course, the goal of Health IT is not simply the digitization of medical records. The object of the game is to improve the delivery of health care. As Cerner's Patterson said, if IT is the investment that will transform the system, we need to be precise about the goals and benefits. In his view, health IT will bring savings to the system and improve workflows in plan and provider offices.  He thinks IT will reduce medical errors because clinical decisions can be based more on evidence and less on human memory. IT will be the glue that brings together the fragmented pieces of the health care system, both clinically and on the health care commerce system.

Peter Neupert, corporate vice president of the Microsoft Health Solutions Group, said there is no disagreement that the enemy of improvement is the status quo and paper. But challenges include inertia, investment and inadequate computer skills. He said HealthVault allows consumers to pull together their health information. (He blogged about the event too).

Mark Smith of the California HealthCare Foundation urged us to think big and different. Health IT isn't just rewiring the system. It's the potential to profoundly change it. Travelocity, he pointed out, isn't just a travel agent with a computer. And Amazon isn't a neighborhood bookstore with a computer. They are new services, on a new platform. And that's how we should begin to think about a wired health care system in our no-longer-too-distant future.

We are hosting our own event this coming Monday on the wireless future of Health IT. It too is about the possibilities that health IT offers our health care system, but less about electronic medical records and more about remote monitoring of diseases and mobile care systems. The bottom line of our event and the Health Affairs event is the same, though—we need to utilize the technology available to us to offer better and more cost efficient health care services to Americans.