States go gently on e-health

Some get going on records systems, but worry about funding, public-private balance

By the numbers

$100 billion

Total cost to digitize public and private e-health records

$7.6 billion

Total state and local government IT spending on health and welfare in 2006

28

Number of states currently planning to implement e-health records systems

A future in which electronic health records are available in real time nationwide could be as much as a decade away, but states today are looking at how to use e-records to improve the citizens' health, track diseases and lower their health care costs.

They have their work cut out for them.

A nationally integrated e-health records system could be run from a consolidated or federated model. But who would control the data, what privacy and security controls regulate data flow, and what technical standards are necessary?

Then there's the knotty issue of integrating public records with private health care providers' data and whether a public-private partnership first must be established.
But perhaps the most pressing question of all is who will foot the bill for such a comprehensive and expensive system.

E-health records, which commercial health care organizations and hospitals are adopting, contain detailed information about a person's medical history from all encounters with a health care provider. Such records, which eventually would be available to doctors anywhere in the United States at the click of a mouse, also include the patient's demographic information and could be used to chart the quality, effectiveness and cost of health care.

E-health records also could be aggregated and analyzed to determine which doctors and what medical approaches generate the healthiest patients, best results and least expensive care, industry officials said.

By analyzing the aggregated data, health care providers can determine more efficient and cheaper ways to care for patients, then share best practices to streamline health care and improve disease management.

By offering visibility into each transaction for each patient, e-health records also can reduce redundancies in the system, cut prescription errors and reduce fraud, waste and abuse, industry experts say.

Because provisions in the Centers for Medicare and Medicaid Service's Medicaid Information Technology Architecture set some early e-health records standards, states are looking at their next Medicaid system contracts as an opportunity to start working toward EHR implementation, said Des Varady, vice president of government services for the health care information and research firm Ingenix Inc. of Salt Lake City.

The architecture 'has started to lay the groundwork for future things like scanning records and more than what Medicaid programs are doing today,' Varady said. With that, the centers and Health and Human Services 'are getting Medicaid programs at the state level to look at this and plan for it more seriously.'

Twenty-eight state governments, including Florida, New York and Texas, are planning to implement some form of system, industry officials said. To allow data sharing on a national scale, disparate systems developed by individual states eventually could be integrated as one comprehensive system.

Nine governors have publicly acknowledged the need for IT improvements in their states' health care systems and, during their annual state-of-the-state speeches, several specifically cited electronic health records as a major need, Input said.

'Electronic health records, e-prescribing and immunization registries'these are all things that, in the long-term, make us as Americans much healthier,' said Gwendolyn Brown, health care policy director for EDS Corp.'s global government affairs unit. 'It's definitely a business opportunity.'

Among the big issues regarding e-health records that still need to be worked out, according to analysts and industry officials, are:
  • What form will e-health re-cords take?

  • Will there be one national data bank or several regional ones, and who will run them?

  • Who will control the massive amounts of medical and personal data?

  • Where will the money come from to pay for it all?

  • What standards will emerge?

  • How will the data be shared?

More than 100 regional health-information organizations that have been experimenting with e-health records are working on these problems. State and local governments are getting involved with regional health-information organizations, partially funding them, taking part in planning or even doing some data exchanges, said Pat Richards, global director for electronic health records at EDS.

But states are not waiting for standards to emerge to begin tackling e-health records, said Chris Mirro, vice president of business development for Affiliated Computer Services Inc.'s state health care practice. ACS of Dallas has implemented e-health records in Missouri, Montana and Wyoming.

For each state, ACS has integrated a portal between Medicaid payment claims information and doctors' offices to give doctors real-time access to information on drugs that have been prescribed for a patient and services that have been performed.
'The best starting point is to build that [electronic] health record based on claims,' Mirro said.

Industry officials agreed that changes in the national health infrastructure would be necessary to facilitate sharing of more detailed information on each patient.

A key issue is whether public-private partnerships will have to be hatched to create one secure database where all records from private health care providers and the Medicaid population could be stored and accessed.

'The public-private partnership is critical to moving electronic health records along through the continuum,' EDS' Brown said. Details on how that might work are complex and far from being ironed out, she said.

Discussions on public-private partnerships are ongoing, but are unlikely to advance without some examples of successful relationships, said James Krouse of market research firm Input Inc. of Reston, Va. 'To date, profit motives don't seem to jibe real well with program delivery,' he said. Florida in 2004 canceled an IT outsourcing project, and several other outsourcing projects in other states have fallen apart in battles over contract terms.

Krouse believes the federal government will have to drive and fund wide-scale adoption of e-health records. States do not have the money in their budgets to tackle such a massive assignment, he said.

The total cost to outfit the United States with e-health records will be more than $100 billion, according to industry estimates. And private industry does not have enough clout to control the process and lead the charge, Krouse said.

As the initiative progresses, there will be plenty of opportunities to go around, Krouse said. The federal fiscal 2007 budget request already has earmarked $166 million for e-health records, and much of that could be doled out as state grants, Krouse said.

E-health records 'are going to drive a ton of work, especially in professional services and systems integration,' he said.

Ethan Butterfield is a staff writer for GCN's sister publication, Washington Technology.

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