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Health
Systems
THE
PROMISE
Entering
the Decade of Health Information Technology |
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By
Brian Raymond, MPH
Health information
technology (HIT) is the underpinning of a vision for the future of American
medicine that is gaining consensus among public and private policymakers
nationwide. As envisioned today, Americans will one day experience a health
care system in which disparate providers across an otherwise fragmented
delivery system will share health records in real time by means of a national
network of electronic medical record systems. The architects drafting
the IT blueprints for an interconnected electronic health infrastructure
represent a public-private partnership that is actively paving the way
toward what the Bush Administration calls the "decade of health information
technology."
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A National Health
Information Infrastructure
The
National Committee for Vital and Health Statistics (NCVHS) has set
forth perhaps the clearest articulation of the vision for health
information technology in its description of a National Health Information
Infrastructure (NHII). It is described as "a comprehensive
knowledge-based network of interoperable systems of clinical, public
health, and personal health information that would improve decision
making by making health information available when and where it
is needed." The NHII is not just a network of information systems
but the standards, applications, and rules that support all facets
of individual health, health care, and public health. The NHII as
envisioned by the NCVHS is based on decentralized networks of voluntary
health information.
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The federal
government has ramped up its leadership role in accelerating health information
technology, and recent national policy developments targeting rapid HIT
adoption are worth highlighting.
- On March
21, 2003, the federal government announced the first set of uniform
standards for the electronic exchange of clinical health information
to be adopted across the federal government as part of the Consolidated
Health Informatics (CHI) initiative.
- On July
1, 2003, the Department of Health and Human Services announced its purchase
of a license that allows all public and private sector parties to use
a medical vocabulary known as the Systematized Nomenclature of Medicine,
Clinical Terms (SNOMED-CT) at no cost.
- On December
8, 2003, the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) was signed into law. The landmark legislation establishes
a voluntary electronic prescribing program and creates financial incentives
for acquiring information technology and authorizes several demonstration
projects on using information technology to improve quality.
- In January
2004, President Bush emphasized the importance of electronic records
in his State of the Union address stating that "by computerizing
health records, we can avoid dangerous medical mistakes, reduce costs,
and improve care."
- On February
25, 2004, the Food and Drug Administration issued a rule that requires
"barcodes" on most prescription drugs and on certain over-the-counter
drugs as a means to reducing medication errors in hospital settings.
Barcodes on drugs and barcode patient wristbands reduce the potential
for medication errors when used with a barcode scanning information
system.
- On April
26, 2004, President Bush established a goal for every American to have
a personal electronic medical record within ten years as part of an
aggressive health information technology plan. He created the new Office
of the National Coordinator for Health Information Technology within
the Department of Health and Human Services to lead the national HIT
effort. In addition, the President doubled funding to $100 million for
demonstration projects on health information technology.
- On July
21, 2004, Health and Human Services Secretary, Tommy G Thompson, and
the new National Coordinator for Health Information Technology, David
J Brailer, MD, PhD, unveiled a strategic plan1 for health
information technology promotion over the next ten years. The plan identifies
four major goals:
- "Inform
clinical practice" by bringing information tools to the point
of care, especially by investing in EHR systems in physician offices
and hospitals.
- "Interconnect
clinicians" by building a health information infrastructure.
- "Personalize
care" by using technology to give consumers more access and involvement
in health decisions.
- "Improve
population health" by expanding the capacity for public health
monitoring and by implementing research advances in public health
care.
Although
health care still lags far behind other industries in information technology
investment, many observers view the recent policy development as a sign
of new momentum gathering the critical mass needed to galvanize the HIT
vision. Whether we are at or near the "tipping point" for HIT--where
the technology adoption rate suddenly switches from incremental to exponential
growth--is yet to be determined. Nevertheless, the health policy community
has clearly moved from talk to aggressive action on health care transformation
with information technology.
Reference
- Thompson
TG, Brailer DJ. The decade of health information technology: delivering
consumer-centric and information-rich health care: framework for strategic
action. Washington (DC): Department of Health and Human Services, National
Coordinator for Health Information Technology; 2004. Available from:
http://www.hhs.gov/onchit/framework/hitframework.pdf
(accessed September 28, 2004).
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