From the December 2006 Issue

Using Data to Drive Performance Improvement in Hospitals

An Ounce of Prevention for the Healthcare IT Network

On Track to Improved Workflow

Accuracy in Motion: Case History

A Tale of Two Attitudes

Benefiting from European HIT Initiatives

By George T. Schwend

George T. Schwend is the president and CEO of Health Language Inc., headquartered in Aurora, Colo. Contact him at george.schwend@healthlanguage.com.

The United States spends more on healthcare than any other country, but lags behind many European countries in deploying healthcare information technology (HIT) systems that improve the quality of care and enhance efficiency. In fact, we are at least 10 years behind many European countries in adopting HIT. Other countries have widely accepted the idea that HIT can lower overall health spending and improve outcomes, a much broader view of their return on investment (ROI) than is accepted within the U.S.

The United States can benefit greatly from other countries’ successes and failures in their ongoing efforts to implement HIT systems with government oversight and support. As early as 1993, Germany started developing a national HIT network. Canada Health Infoway plans to have electronic health records (EHR) for half the population by the end of 2009. The UK has established the National Programme for IT, the most comprehensive HIT system under development. It includes an integrated care record service, an electronic appointment system and an electronic prescription transmission service that will be accessible to all major healthcare providers by 2014.

Follow the Leaders
In sharp contrast, the United States does not have a mandated system for storing, sharing and exchanging HIT. Instead, it has a tangled and fragmented web of information that is housed in separate silos. Even within a hospital, information cannot be easily shared or accessed between departmental systems. With no common language or infrastructure, inefficiency reigns. As seen in European HIT initiatives, promoting the use of common terminologies nationwide reduces medical errors, lowers costs and improves outcomes.

Historically, U.S. healthcare organizations have underinvested in technology; IT resources often were relegated to billing, not to addressing broader clinical benefits. Also historically, allocation of gross revenues for healthcare IT was only 50 percent of what other information-intensive industries invested. It’s encouraging that we are beginning to see healthy investments in clinically oriented technology that is more portable, accessible and reliable.

The U.S. government needs to follow European governments’ examples in demonstrating strong leadership to drive national healthcare technology initiatives that will foster greater efficiency and higher quality patient care. In particularly, the government must set the criteria for standards and performance, then fund the necessary infrastructure to eliminate entrenched information silos and allow information to flow. By implementing a linked system of information, the United States can benefit from overall savings, better clinical outcomes, and a healthier population. This is particularly important as people age and must rely on multiple healthcare providers to treat a variety of chronic conditions and diseases.

Even with a single-payer system, Australia, Canada, Germany, Norway and the UK all began their HIT with fragmented and incremental processes that lacked interoperability. They realized the need for a national standard and mandates to move forward. Governments also are using public funds as incentives to get more providers onboard with applying HIT. Now, President Bush is trying to encourage the industry to move in the right direction, while European countries already have received their marching orders.

We need to prepare our systems for future levels of interoperability and communication. The U.S. Department of Health and Human Services (HHS) has already taken important first steps by creating the American Health Information Community to develop common standards and interoperability while ensuring privacy and confidentiality. At the request of HHS, Health Level Seven interoperability standards are being adopted for clinical and administrative data on various computers to communicate while preserving meaning. HHS also has signed a licensed agreement to provide the SNOMED CT (Systemized Nomenclature of Medicine Clinical Terms) across the country.

Recent mandates require that government purchases should help speed the adoption of HIT. President Bush’s health information technology plan is an important part of his overall healthcare agency to make America’s healthcare safer, more accessible and more affordable. The President has ordered the development of an EHR for every citizen by 2014 and created the Office of the National Coordinator to drive the effort and create a nationwide health information network.

Unfortunately, as of the end of September, legislation (HR 4157 and S 1418) promoting the implementation of HIT is stalled. Hopefully, the House and Senate can reconcile their differences and pass a bill that will accelerate the use of HIT to improve efficiency, enhance patient care, reduce medical errors and provide greater security. We need to get things moving.

Estimating Total Cost
How much is it going to cost? Patient safety and IT expert Rainu Kaushal, M.D., M.P.H., an instructor at Harvard Medical School and a staff physician at Brigham and Women’s Hospital, Children’s Hospital and Massachusetts General Hospital, predicts that the largest costs in establishing a national HIT network in the United States within five years will be $103 billion in capital costs and $53 billion in interoperability costs. U.S. hospitals are expected to incur the highest functionality costs ($51 billion), followed by skilled nursing facilities ($31 billion), and office practices ($18 billion). However, projections should be viewed with some skepticism. Other countries initially underestimated the cost for HIT implementation; we should learn from their miscalculations.

European countries have done much of the pioneering work, and we can certainly benefit from their experiences, both good and bad. Let’s import the best lessons and commit to a national HIT system that works for the United States. Government must lead by example and by financing the required infrastructure and establishing the technology criteria that will deliver the rewards of communication and interoperability. By taking a broader view of HIT implementation beyond the traditional narrow ROI analysis, we can improve healthcare delivery, resulting in a healthier population and an improved healthcare system.