Health IT

We'd like to encourage our readers to attend our event this Monday, March 23, The Wireless Future of Health IT. The event will be hosted by Intel Chairman Craig Barrett, a strong believer in the benefits of using technology to deliver high quality care anywhere and everywhere.

If implemented, Health Information Technology has the potential to both control costs and improve health care outcomes. Everywhere there is a broadband internet connection, health care providers will be able to easily transport medical information, cut down on paperwork, and reduce medical errors. Health IT has already been given a place in the economic stimulus package.

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.

Want to track the health care money in the stimulus package? Have we got a web site for you.

The Department of Health and Human Services has created a special office to distribute the $137 billion in Recovery Act funds under HHS purview. The Office of Recovery Act Coordination will be lead by Dennis Williams, formerly of HRSA. Details of spending, grants etc will be at www.hhs.gov/recovery.

More than $3 billion has been distributed so far, mostly to community health centers and Medicaid.

It's not just the blogosphere that's agog about some of the pretty astonishing things being said about comparative effectiveness. Steven Pearlstein's Washington Post column debunks some of the wild arguments being made against the comparative effectiveness and health IT provisions in the stimulus bill. Pearlstein provides an insightful look at how the controversy got started and addresses the alarmist rhetoric. He rightly points out:

There's nothing particularly new about comparative effectiveness research—the National Institutes of Health, along with the Agency for Healthcare Research and Quality, have been doing it for years, with a budget last year of about $335 million....nearly all experts agree (comparative effectiveness research) is a necessary first step to reforming a broken health-care system.

Pearlstein punches holes in the argument that the research would lead to denial of appropriate care and makes the case that our health system would be, well, healthier if we had better information on what works and what doesn't:

Congress is set to pass a $787 billion economic stimulus package—with more than a $130 billion in health-related funding. The House is expected to vote this afternoon, with the Senate scheduled to follow suit this evening.

Congressional leaders worked late into the night Thursday, to reconcile he House and Senate versions of HR 1. The conference report detailing the compromises in the final legislation is available from the House Committee on Rules. Just how late were lawmakers up hammering out the details? The 496-page pdf is filled with handwritten notes and last-minute edits.

Two new reports provide further insight into Health IT's potential as both economic stimulus and a building block for broader health reform.

In a letter to Rep. Henry Waxman (D-CA), chair of the House Committee on Energy and Commerce, the CBO estimates that the Health IT provisions of House's economic stimulus package would reduce healthcare spending by 0.3 percent from 2011 to 2019. CBO predicts the savings would come from: "diminishing the number of inappropriate tests and procedures, reducing paperwork and administrative overhead, and decreasing the number of adverse events resulting from medical errors."

A new report from the Commonwealth Fund published in the Archives of Internal Medicine provides even more specific evidence of potential savings by comparing the use of health IT in a diverse group of urban hospitals in Texas. The report's authors conclude that:  "Hospitals with automated notes and records, test results, order entry, and clinical decision support experience fewer complications, lower mortality rates, and lower costs." For a breakdown of the savings, check out this helpful Commonwealth Fund chart below:

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:

Traditionally, the down payment for a prospective home buyer has been around 20 percent (hat-tip to David and New America's Asset Buidling crew). If that's the case, then the $825 billion in economic stimulus plan released today by House Democrats looks like a serious down payment on health reform. More than 25 percent of $550 billion in new federal spending us going toward health-related items (the remaining $275 billion is slated for temporary tax cuts).

You'll find the full the 258-page bill here, an accompanying report here, and a press summary here. Below, we've highlighted some of the major health care components of the proposed legislation:

Health IT, a component of health reform, will likely be part of the economic stimulus package being developed in Congress.

One key supporter includes President-elect Barack Obama. In his weekly radio/internet address this past Saturday, he told listeners:

We'll create hundreds of thousands of jobs by improving health care—transitioning to a nationwide system of computerized medical records that won't just save money, but save lives by preventing deadly medical errors.

In a report released the same day detailing the new administration's plan to save or create at least 3 million jobs, Obama's economic advisors estimated that at least 244,000 of those jobs would come in health care, a sector that could be spurred by stimulus investments in health IT.

USA Today’s Julie Appleby lines up the odds for and against health care reform in the new administration. In addition to the usual “we can’t afford to” versus “we can’t afford not to” arguments (President-elect Obama has declared himself in the "can’t afford not to" camp) she has a great outside-the-Beltway comment. Phyllis Smith, 60, an uninsured Obama backer from Texas who can’t afford her blood pressure and diabetes medicine wonders with the world being the giant mess it’s in, whether Obama can try to fix it all at once.

"With the condition this world is in right now, that man has his hands full," she told the newspaper. "Whether I get my high-blood-pressure medicine is not going to be high on his priority list. It will take time. … Until our Congress agrees to work together, there's not going to be a whole lot of hope."

Back here inside the Beltway, we do see some signs that Congress might be ready to work together, although it won’t all be smooth sailing. But we know that House leaders as well as the Senate is revving up for action in 2009.