ANOTHER VIEW—Commentary

Warren Suss | The high-stakes game of information exchange

Warren SussThe stimulus package and the 2010 budget proposal from President Barack Obama underscore the central role of improved information exchange in achieving top-priority national objectives.

Consider federal health information technology. The dollar stakes are sky-high. The stimulus package allocates $19 billion toward achieving improved exchange of medical information. The Obama budget sets aside $630 billion for a health care overhaul, which will require improved information exchange to achieve its objectives.

The stakes are also high in terms of the number of entities involved. The Federal Health Architecture (FHA) program will coordinate the efforts of 26 agencies across the government to advance the exchange of health information within the federal arena and among federal, state, local and commercial institutions.

Likewise, the major technical, management and cultural challenges associated with health IT information exchange, beginning with health record interoperability, privacy, portability and security. There are specialized human factors associated with the impact of electronic and personal health records on physician, nursing and administrative workflows. Even fundamental issues such as patient identification numbering systems, biomedical terminology, measurements of behavioral health data, and the creation of longitudinal records across institutional boundaries are works in progress.

Despite the challenges, there’s no question that we will achieve results. The FHA has already developed a gateway for establishing the secure exchange of medical records, and the Social Security Administration has implemented it with a successful pilot program.

The question facing federal IT managers and executives at the front lines of federal information exchange initiatives is whether we will achieve high-stakes results that match the magnitude of the challenges.

The SSA pilot program is encouraging.

First, the program has an enormous potential impact. Today, it takes 80 to 90 days to resolve the medical portion of a disability claim. Most of that time involves getting the right medical information securely into the hands of the people who can adjudicate the claims. Delays have contributed to a huge backlog of unprocessed claims. The pilot program demonstrates that, once the right systems are in place, SSA can request and receive the information needed to resolve a claim in less than a minute instead of months.

Second, the pilot program creates incentives to motivate success. SSA pays hospitals for sending SSA records. However, with time-consuming manual record retrieval, it can cost hospitals a lot more to retrieve and send the information than the amount they get reimbursed. By automating the process, hospital costs for record retrieval and transmission drop significantly, and the hospitals can make money by processing each request.

Third, the SSA program is using advanced technology strategies, including computer analysis, to address tricky challenges, such as compliance with privacy laws, including the Health Information Portability and Accountability Act, and retrieval of health record components from multiple departments in a hospital.

The SSA information retrieval pilot program points the way to future success in the upcoming wave of high-stakes health IT initiatives. We need to measure our progress in terms of high-stakes results. Are we improving the government’s ability to deliver key services and achieve tangible, significant benefits for our citizens? Are we creating a system of incentives that will motivate continuous support and participation by information providers and consumers? Are we working out solutions to the tricky technical, management and cultural challenges that can present barriers to program success?

This high-stakes, high-reward calculus is not limited to the exchange of health IT information. High-stakes information exchange challenges will be central to many of the recently announced federal initiatives in energy, education and the environment. And there will be more to come in other areas, including cybersecurity, coalition warfare and law enforcement.

This is a time for bold thinking and dramatic action. Improved federal information exchange has the power, literally, to cure our nation’s ills. But it will only happen if we keep our focus on high-stakes results.

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