Medical Device Daily Washington Editor

WASHINGTON – The Summit 2006 meeting of the Healthcare Information Management and Systems Society (HIMSS; Washington) on Wednesday featured a roster of nationally recognized figures in healthcare, all of whom urged stakeholders to keep up the pressure on Washington to pursue broad-based computerization for improved healthcare delivery.

At the same time, they noted that the private sector also has a bit of work to do in terms of offering incentives for providers and influencing our mindsets regarding the benefits of the information age.

Dr. Carolyn Clancy, the director of the Agency for Healthcare Research and Quality (AHRQ; Washington), said that since 2003, she has tried “to make it abundantly and redundantly clear” that implementation of healthcare information technology (HIT) is essential to improving American healthcare quality.

Clancy said that several lessons have emerged from the effort to put HIT in place.

• The first: “It's not the technology, its how you use the technology.” Different establishments will deploy HIT differently for a number of more or less obvious reasons, she said, including the function of the facility and the software provided by the vendor.

• Lesson No. 2: “Evidence is important” in a way that makes healthcare an industry different from most others. Some observers, Clancy remarked, saw healthcare and IT as “a marriage waiting to happen.” But she expressed little appetite for the idea that the slow pace of penetration of data processing into healthcare indicates that the industry is made up of “just laggards,” with no good reason for not having gone farther into the Information Age.

• Clancy's third lesson: that evidence “isn't everything,” and she observed that innovation almost always relies on a vision of tomorrow that may or may not resemble the moment.

While healthcare's progress in building an IT infrastructure has been, by some counts, less than impressive, she insisted that “the picture can change and we can help change it.” She insisted also that a validly functioning HIT system “must be embedded in the practice of medicine” in times to come.

Two concerns that must be addressed include a patient's privacy interests and a clinician's reluctance to share his/her experiences with others due to concerns about second-guessing. “Trust is the key” to dealing with this and other roadblocks, Clancy noted.

Newt Gingrich, former speaker of the House of Representatives and the founder of the Center for Health Transformation (Washington), lauded the efforts of the HIT community, saying that “they're doing an immense amount of work” toward rolling IT into healthcare and that “constant innovation” is one of the driving forces behind broadening acceptance of the idea.

Gingrich urged the attendees to “constantly go back again and again to set the right standards” for implementation as time goes on in order to ensure that these best standards are applied over time.

“It is important that you pay constant attention to the actions of the legislative and executive branches in this endeavor because they have other priorities as well and could lose sight of this endeavor,” he said. And he recommended market-oriented development of standards because of “broken bureaucratic structures that don't always work,” and urged that proponents maintain an important drumbeat – that “paper kills.”

He cited Piedmont Hospital (Atlanta), said to have put in place an electronic health system that cut medication errors from roughly seven per thousand to less than one.

And Gingrich commented that another example of the faults of paper were demonstrated in the fallout from last year's Hurricane Katrina in that many of the residents of New Orleans who were in treatment for cancer ended up at the M.D. Anderson Cancer Center (Houston) with no records of just how far their treatments had gone and little certainty as to precisely what their diagnosis had been.

Gingrich said that the Bush administration's ideas about digitizing healthcare data were “on the right track,” but he chided the president for not being “bolder and more aggressive.”

He also cautioned against complacency about the legislation that goes around on The Hill. “If Congress can't tell you what the law should be, you tell Congress what the law should be.”

In terms of economics, he said, “The budget is never too tight for a bridge to nowhere,” he observed, a reference to pervasive unnecessary pork.

Also presenting was David Brailer, MD, the first National Health Information Technology Coordinator and now the vice chairman of the American Health Information Community, a federally chartered commission with 17 members from the public and private sectors.

Brailer said, “the progress that has been made and is being made” is of the utmost importance because government “cannot set the standards” due to technological and regulatory deficiencies.

He insisted that “we have tough decisions” to make in developing the first round of standards in September, the subject of a joint effort between the American National Standards Institute (Washington), the Advanced Technology Institute (North Charleston, South Carolina), Booz Allen Hamilton (McLean, Virginia) and HIMSS.

Brailer called for “seamless adoption” of HIT, but he also noted the numerous competing needs for the federal dollar as a key barrier for accomplishing seamlessness.

He cited the potential hang-ups as privacy, licensure and reimbursement, but, despite these, urged stakeholders “not to ease up on your efforts to communicate the importance” of HIT to Congress.

Mark McClellan, MD, administrator of the Centers for Medicare & Medicaid Services (CMS), said that what he sees “is a critical mass coming together” in adoption of standards, but with HIT “still underused” even in the private sector.

“Many executives still believe that healthcare IT does not pay off,” McClellan remarked. Executives in other industries typically are rewarded for improved performance, but “you often get paid less” for improved outcomes in healthcare, he argued.

He noted that CMS is working to revamp its systems of reimbursement to remove some of the what he called the “perversions” of incentives, saying that the agency “is working hard” to reverse this trend.

“When we pay more for better quality, outcomes will improve,” McClellan observed.

The former head of FDA said that HIT systems are not “a one-size-fits-all” proposition, and he insisted that at least one demonstration project strongly makes the case that a pay-for-performance mindset can improve outcomes and trim away at the cost of healthcare.