Operation health IT

'Rather than saying what standards you want, we're going to say what business problems do we want to solve and then figure out what standards we need to do that.'

- David Brailer, National Coordinator for Health IT

A consumer in the not-too-distant future will go to a drug store and pick up a prescribed medicine, knowing that the pharmacist has received an electronic order from a physician. The prescription will have been checked against the patient's record for dosage, drug interaction and allergies, all without paperwork.

Electronic prescribing is a likely early use of the branch of records management and information sharing known as health IT, for which the government is seeking standards. And e-prescribing is the beginning.

The Health and Human Services Department, which is leading the federal health IT effort, is pursuing interoperability standards so physicians and hospitals can exchange patient information no matter where a patient is within a state'and, eventually, in the country.

Several events over the next two months will boost HHS and industry efforts toward developing standards for health IT interoperability.

Health IT is intended to improve the quality of medical care, cut costs and reduce medical mistakes. Up to 100,000 Americans die annually from mistakes such as misreading illegible prescriptions or treating a patient for the wrong condition because of incomplete medical records, according to an Institute of Medicine study.

President Bush last year set a goal to provide electronic health records for most Americans by 2014. HHS is working on a three-year timetable for tangible results, such as a patient medication record or early alerts for flu epidemics or possible bioterrorism events.

'We want to have a suite of standards for the basic set of ambulatory (outpatient) transactions done in seven months,' said David Brailer, the National Coordinator for Health IT, located in HHS.
The government has a huge financial interest in promoting standards to drive health IT adoption. It pays about $850 billion a year'about half of all U.S. health care when Medicare, Medicaid, federal employees' health benefits, and programs within the Defense and Veterans Affairs departments and the Indian Health Service are combined, HHS officials have said. And the new Medicare drug benefit, slated to begin in January, will add to that.

With annual private and public health care costs totaling $1.7 trillion and rising, HHS said health care spending accounts for nearly 16 percent of the total economy.

Over the next several weeks, HHS plans to usher the pieces into place to make health IT a reality. They include:
  • The debut of the American Health In- formation Community, a public/private collaborative group

  • The awarding of several contracts in late September and October for product certification compliance, health information infrastructure prototypes and the assessment of state privacy rules

  • A report from the federally sponsored Commission on Systemic Interoperability that will guide AHIC with initial cases for standards.

AHIC, which will be made up of federal and private physicians, hospitals, insurers, community clinics and software vendors, will prioritize the early cases, make the final business recommendations and set a timetable for standards, Brailer said.

'In the end, though, this is a voluntary process we're trying to engineer,' Brailer said.

Under the contracts, HHS will ask vendors to harmonize standards, which in- cludes identifying and prioritizing business issues and standards for the 'breakthrough' cases that AHIC recommends. In addition to e-prescribing, HHS Secretary Michael Leavitt has cited adverse event drug reporting and bioterrorism reporting as two initial breakthroughs or business cases for which to determine standards.

The contractor will have three months to come up with the key duplications, barriers and holes in existing standards and the process to resolve them, he said.

HHS also will release the final Medicare e-prescribing foundation standards this month as part of the Medicare Modernization Act
A lot of the work around standards harmonization has already taken place in the private sector, said Janet Marchibroda, CEO of the eHealth Initiative, a nonprofit group of industry, public health, research and academic organizations.

'It's inserting government into that process that gives you the critical mass. We don't need government to develop standards, but we need them to weigh in,' she said.

What's needed in most cases is not the development of new standards but agreement to adopt many of the existing standards in health care, she added.

'AHIC will help to nail that down and say, 'Yes, we're going to migrate to these standards,' ' she said.

The first step is getting consensus on the standards and then giving public and private providers and payers adequate time and incentives to get there.

'Rather than saying what standards you want, we're going to say what business problems do we want to solve and then figure out what standards we need to do that,' Brailer said.

The National Institute of Standards and Technology also will take the AHIC recommendations and develop a Federal Information Processing Standard so federal and private-sector requirements are aligned.

Officials also expect to use standards recommended under the existing federal Consolidated Health Informatics E-Government initiative, and draw on the Federal Health Architecture.

At the same time the government is pushing for standards, more than 100 local and regional health information networks already exist around the country in different stages of development. While HHS recognizes the grass-roots dedication of early health IT adopters, they may want to protect themselves against standards that will not be dictated by mandate but have a lot of purchasing power behind them, Brailer said.

'We don't want to stab the innovators in the back,' Brailer said.

Meanwhile, Medicare is moving toward identifying, measuring and supporting high-quality care, which gives Medicare beneficiaries better outcomes at a lower cost and away from simply paying more for more care, said Mark McClellan, administrator of HHS' Centers for Medicare and Medicaid Services.

'Right now, if you take those steps in Medicare, you get paid less. That's going to change,' McClellan said.

Under the Medicare prescription drug benefit, drug plans will have to support the e-prescribing foundation standards. E-prescribing is not required, but if a physician does e-prescribe medications it must be via those standards.

In January, CMS will begin testing the e-prescribing standards, which include a message standard that allows for all the information needed in a prescription to be transmitted in a common format.

CMS already has an e-prescribing pilot in Florida for its physicians with the largest Medicaid clientele. The pilot has lowered drug costs and discouraged fraud, McClellan said.

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