A Federal Jump-start for Health IT

In a landmark government effort to drive American health care into the information age, the February 2009 stimulus bill earmarked about $30 billion in incentives for doctors and hospitals who install electronic medical records—paying up to $63,750 to individual physicians and millions to hospitals.

Now comes the tough part: implementing “EMRs” and proving they really can reduce medical errors or get doctors to keep better track of chronically ill people. As National Coordinator for Health IT, Farzad Mostashari oversees federal efforts to promote adoption of EMRs and to prod reluctant hospitals to share patient data.

Mostashari was recruited to take over the federal effort in February, after leading a patient-records initiative as an assistant health commissioner in New York City. He spoke with Technology Review’s chief correspondent, David Talbot, about when we’ll start seeing evidence that the technology is working.

TR: What problems are we attacking with this huge medical IT outlay? 

Mostashari: Start with “First, do no harm.” Right now we do harm to patients through health care. The estimates, conservatively, are 100,000 to 200,000 people killed each year by things like hospital-acquired infections and adverse drug events. Electronic medical records provide an opportunity to create standardized protocols, to provide decision support and reminders for doctors, and to tell them about the patient’s medications and drug allergies, as well as any dangerous drug interactions, at the point of care. Those are all proven interventions.

What else can software do besides cut back on accidental hospital deaths?

All too often, people come into the doctor’s office with high blood pressure which will kill them from stroke or heart attack, but the patient is complaining about something else. Doctors can get distracted and not pay attention to the most important thing—which might be that the patient’s blood pressure is out of control, or the flu shot that hasn’t been given. Electronic records can make it easy to provide these reminders. It can also make a list of patients who have not come in, who have high blood pressure or diabetes, and must be seen.

Why is the health-care industry so far behind other industries?

Unfortunately, the business case often has not been strong enough to support adoption and use of electronic records.  But we have now reached a point where the incentives are turning the other way—with greater emphasis on paying for outcomes and value rather than volume.

Bring us up to date since February 2009, when the bill passed. What is the progress to date on getting the IT installed?

The ice has broken after decades of talk. Back in 2009, only 10 percent of hospitals and 20 percent of primary-care providers used basic EMRs. Within a year, the doctors went from 20 percent to 30 percent. I expect it to get to 40 percent this year. We have about 10,000 new providers a month registering for incentives. About $400 million has gone out in payments already, and is expected to hit the $1 billion mark by early 2012.

But this is more than installing software—it’s about a concept called “meaningful use.” The health IT incentive payments are predicated on very specific criteria. For example, the electronic health record must contain blood pressure readings, height and weight, lab data, the patient’s problem list, and allergies; the patients’ preferred language will be recorded; and the system must have a whole series of functionalities around sharing information with patients and public health agencies.

How are the hospitals doing? The American Hospital Association is complaining that they have too many requirements and regulations to comply with.

It is more difficult for hospitals, but there is a huge level of engagement on their part. Ninety percent of hospital CIOs say that getting to “meaningful use” in the next two years it a top priority. We’ve hit the balance of making it achievable, even though it’s ambitious. This is hard. Change is not always easy.

Is there evidence that all of this is having an impact?

In about 18 months we expect to have data from specific study areas. We have established 17 “beacon communities” that form a microcosm of America, from Mississippi to Maine. These “beacons” are clusters of health-care providers that have done pioneering work on using health-information technology to improve care. They are rigorously measuring indicators around quality, safety, and cost. A lot of them are looking at diabetes care—cost and quality of care—some are looking at issues like childhood asthma.

What about the $2 billion you are spending on “health information exchanges,” wherein hospitals are supposed to start electronically sharing patient data with each other?

We’ve done important things; the standards and protocols for sharing data are in place. But the problem with information exchange is not the technology—it’s around the business case. All of a sudden we are seeing [hospitals] waking up and saying, “Uh-oh, the game isn’t about me keeping information to myself so patients come back to me, it’s about accountable care—because I don’t want another emergency department to repeat the CT scan I gave.” People are seeing it’s in their own financial interest to do the exchange. We are reflecting this concept in regulation so that you can’t use information to lock in patients by locking in their data.

How are you going to get patients to play a bigger role in their health care? We recently witnessed the shutdown of Google Health, which was built to let people import, analyze, and manage such data.

The failure of Google Health was partly due to the difficulty people had in getting their data into the system. All too often, people had to spend hours typing it in—so it became a glorified word processor. But Google Health was a call to arms that says people have a right to their health record. A lot of institutions don’t make it easy. Part of this is about let’s change that, let’s reverse that—let’s make it easier.

Is some new and more patient-centric federal effort coming?

Stay tuned. What we can do is lead, convene, put out a call to arms, and set standards. We can include patient access as a “meaningful use” of electronic records. Ultimately, it’s going to have to be patients and providers getting across the idea that—as someone put it—the most underutilized resource in health care is the patients themselves.