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Health Information Technology: The Road Ahead

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Carolyn M. Clancy, M.D., Director of the Agency for Healthcare Research and Quality

Annual Conference of the Healthcare Information and Management Systems Society (HIMSS), Dallas, TX, February 14, 2005

Sincere thanks to all of you who are here.

There is so much happening, so fast, in the area of health information technology. It goes without saying that HIMSS has a wealth of expertise that we cannot do without. And I want to acknowledge the leadership of Steve Lieber, your president and CEO, in pulling together the unique resources of HIMSS to help navigate the storm.

Let me start with one thing that is certain—our new Secretary of HHS, Mike Leavitt, is a long-time friend of Health IT [health information technology]. He has background and a track record. While he was governor, Utah built a base that makes it one of the nation's leaders in health information connectivity. And AHRQ is happy to have awarded one of our five Health IT state contracts to Utah last year, to help them build further toward an interoperable health information system.

Secretary Leavitt's first full day on the job was spent on Health IT. He joined the President at the Cleveland Clinic last month as part of a public conversation about the importance of health information technology. Dr. Martin Harris also helped out as part of that conversation with the President—he's the chair of HIMSS' RHIO [regional health information organization] Task Force, one of your many task groups working on Health IT, and again we thank you for those efforts.

The event at the Cleveland Clinic helped move the discussion by making it clear to Americans that we need not only electronic health records, but also an interoperable system of health information exchange. In the President's words, a "medical Internet."

Interoperability is the key to achieving the ultimate goal: To get the right information, for the right patient, at the right time and place. That's a long way from where we are today—and no one knows better than this audience how complex the journey will be to get there.

Our National Coordinator for Health Information Technology, David Brailer, put out a call for information last fall just to make sure we have the right pieces in view—before we even consider how to organize them. One of the responses to that request came from 13 of the leading organizations and associations in Health IT, who joined together in one voice. HIMSS' executive vice president, Carla Smith, was instrumental in that effort, and I want to congratulate her. With so much activity in so many different areas, it will be crucial to communicate and collaborate across traditional lines.

Only a year ago, few Americans had thought about the potential for health information technology in health care. One survey showed that many Americans assumed electronic health records were already in place.

Today Health IT is truly on the national marquee. Americans are quickly coming to understand how much we have to gain from Health IT. And one thing about Americans—we don't like to wait.

With Health IT now at center-stage, I think there are a few potential hazards that we should be alert to:

  • First is the simple danger of impatience. We need a sense of urgency, of course—but we also need to resist the temptation to take counter-productive short-cuts. Once the benefits are understood, people are bound to ask: Why not a Manhattan Project? Why not just require physicians and others to invest now? There will be temptations to use government mandates and resources to accelerate the process. But mandates that may look "efficient" today are too likely to become the institutionalized dead-weight of tomorrow.
  • Our Nation faces enormous health care challenges in the years ahead, and Health IT is one important part of the solution. But it's not a silver bullet, and it won't be quick or easy. There's no substitute for the work that needs to take place on many different fronts. It must be an evolutionary process—even if it's a fast evolutionary process.
  • We also face the challenge that confronts "first movers" in any technology market. Early products won't deliver all the advantages that more mature products will, and some approaches may get left behind entirely—so buyers hold off. Yet we certainly want to encourage investment. The effort now being led by the private sector to "certify" Health IT products will help in making those investment decisions. One bright line to keep in mind is the ultimate goal of connectivity. I hope at this point we'll focus our efforts on products that move us toward connectivity, and leave behind those that might merely perpetuate information silos in electronic form.
  • Finally, if Health IT may seem to be advancing slowly, there will be the temptation to blame—especially, to blame physicians for not moving faster to invest in Health IT products. Whatever their limitations as computer experts, physicians know their practices—and they are the customer. We should offer help with their computer needs. But if they're reluctant to invest, we also need to listen and learn why. We need to understand the barriers, and we need to know what kinds of products and features will truly "connect" with their practices.

All of these are good problems to have. They are the problems of a technology that's ready for take off. The tasks are being defined, and the demand is growing. And don't underestimate the importance of consumer expectations. We talk about empowering patients through Health IT—their first taste of power may come when they demand that their own health care providers get wired.

My agency, AHRQ, and our predecessor agencies under the Public Health Service have helped lay the groundwork for this day. Our support for health informatics products actually stretches back 30 years, and a number of heath informatics products were developed with AHRQ support.

Our current Health IT Initiative grew out of our patient safety efforts. Last year, we awarded some $50 million to more than 100 communities, hospitals and others to plan or implement Health IT systems. We also awarded contracts to help develop statewide systems in five states. Altogether we'll invest $139 million over 3 years for these projects.

We focused our grants especially in rural and underserved areas, to help Health IT get a foothold in some of these areas. But the most important aspect of these projects is not merely as seed money. More important, these are opportunities to measure Health IT in action. Each of these projects will undergo systematic evaluation. They constitute a real-world laboratory, where we'll be able to observe:

  • Different Health IT applications.
  • How they work in real clinical life.
  • The value they add.
  • The challenges they may pose.

That will help us build a business case based on practical experience, not just theory. It will help bring about refinement of Health IT applications. And the information will be shared through our new AHRQ National Resource Center.

By examining Health IT applications in working settings, these projects will help show us something about the human side of health information technology—the impact on providers and patients.

These days, the "T" in Health IT gets much of the public attention. But the "H"—better health care and better health outcomes—is what Health IT is really about. We're building a technical foundation... but the technology is not an end in itself.

Our goal is to support decisionmaking in situations that are deeply personal and often intensely emotional. In those moments, Health IT needs to make the human interaction more effective, not more difficult. It needs to give the clinician more time to interact with the patient, not less. It needs to provide more information output than it requires in input. Wherever possible, it needs to anticipate the patient's needs, with reminders or other information keyed to that particular patient's situation.

So at the same time that we're establishing our technical protocols and standards, we also need to be developing products that facilitate the human interaction between provider and patient—along with products that empower health care consumers themselves.

I hope we won't wait to give as much attention the human effectiveness of Health IT as we give to its technical effectiveness. That means developing prototypes now and testing them.

And we need to think more about the "I" in Health IT—especially, getting information into usable formats. This goal is especially important for AHRQ, because it goes to the heart of what we do as an agency.

I could say that "quality" is our middle name at AHRQ—except that, in fact, it's our surname. It's who we are and what we're about. Our long-term programs to support evidence-based medical practice, and patient safety practices, are about finding what constitutes proven quality in health care.

One of our greatest challenges has been how to get this information to clinicians. Health IT should be an important vehicle for reaching clinicians and helping make evidence-based practice a reality—but only if the information is in usable formats. The most difficult challenge confronting busy clinicians is the inability to determine in "real time" whether information needed to address a patient's problem exists. It's often impossible to know whether the information exists, but isn't accessible... or whether the question at hand hadn't been examined. Neither physicians nor patients have "library time" built into their limited time together.

We need to find ways to provide evidence-based medical information quickly and succinctly for clinicians. At its best, Health IT should be capable of providing decision support at any point where it's needed—whether that's an office desktop computer or a bedside handheld device.

Health IT is an information delivery system—but delivery alone isn't enough, if the information isn't usable where it's needed. New forms of information packaging and presentation will be important in helping Health IT reach its full potential. My agency, of course, produces a wealth of information in multiple areas. We will welcome any opportunity to work with vendors to incorporate our data into decision support and other systems.

These are a few of the challenges. There's no shortage of work ahead. For government, that means addressing legal and regulatory questions that have been raised by Health IT. As you know, the Centers for Medicare & Medicaid Services (CMS) issued its E-prescribing regulation ahead of schedule. It means:

  • Convening public and private sector participants and helping settle common standards.
  • Continuing to lead by example—including a better job of organizing and presenting our own health information on the Web for consumers.
  • Demonstration funding for small practices and solo providers, and support for regional collaborations to begin building interoperability, and the collaborations that will make it work.
  • Watching this technology develop and assessing the possibility of incentives for Health IT investment, especially for smaller practices.

At the same time, we need to remember there is no substitute for the private market in developing complex and cutting-edge systems. We want to be able to move rapidly toward new opportunities. We want continuing experimentation and a willingness to take risks, with ready access to resources. Ultimately, of course, we want ever-improving products that our medical professionals will seek out and use. All that means we need the give-and-take of the marketplace.

When we talk about Health IT, it's tempting to say that health care has been a laggard industry in adopting information technology. Perhaps it has been—but I also think technology has now reached a level of sophistication that can make it truly useful for the full range of health care uses. Health care is not an ATM or a ticket service. It is subtle, and complex, and personal in a way that comparing airfares just isn't. Banks have the benefit of an elegant system of 10 Arabic numerals. SNOMED® [the Systematized Nomenclature of Medicine] has 357,000 concepts.

When we achieve interoperable networks that deliver sophisticated, patient-specific information whenever and wherever needed, securely and privately, we will have accomplished something new. Technology will have taken a step, just as health care will.

The race to Health IT has truly begun. We need to remember it's a marathon. But we need to run it like a sprint. So I hope you're all following those recommendations for 90 minutes of exercise a day.

We have an unusual opportunity to improve health care delivery and improve the health of the American people. AHRQ is anxious to work with all of you to take full advantage of that opportunity.

Current as of February 2005


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