Health Information Technology
August 2004
New Momentum for Interoperable Health
Information Technology
Recent events demonstrate that momentum is growing in both the public and private sectors toward the development and adoption of interoperable health information technology. Executive Order 13335 established the position of National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services (“HHS”). The National Coordinator was directed to develop “a strategic plan to guide the nationwide
implementation of interoperable health information technology in both the public and private health care sectors.” David Brailer, M.D., Ph.D., a pioneer in developing community health information exchanges, was appointed to serve as the National Coordinator on May 6, 2004.
On July 21, 2004, Dr. Brailer published a report entitled “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care.” This report, released at a national summit on health information technology, presents a vision for a nationwide interoperable health information
infrastructure, as well as a framework for establishing that infrastructure (“Framework”). This Framework has been embraced by government and industry leaders and is likely to result in significant new public and private sector initiatives. The Vision
The Framework envisions a consumer-driven health care system where information regarding medical and prescription history, test results, and diagnoses would be electronically accessible to
patients and their providers. This vision also calls for decision-support tools that would guide patients and their providers to clinical best practices thereby reducing costs and improving health care quality. Finally, communication among the various holders of health care information is considered critical to improving public health and advancing clinical research.
In order for this vision to become a reality, health care information must be captured electronically, systems must be able to
communicate with one another, and recipients of health
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Hogan & Hartson Contacts
Partner/CounselDonna A. Boswell - Washington, DC
Barbara Bennett - Washington, DC Thomas N. Bulleit - Washington, DC Marcy Wilder - Washington, DC Brian D. Gradle - Washington, DC AssociateBartley L. Barefoot - Washington, DC
Melissa K. Bianchi - Washington, DC Danielle M. Drissel - Washington, DC Melissa B. Levine - Washington, DC EXEC template_contacts_qsp 1
information must have a common ability to read and use the information provided. Together, these elements are referred to as interoperability. Historically, the decentralized nature of health care practice and the perceived costs of transition to electronic collection of health information undercut the demand for
interoperable health information systems. Dr. Brailer’s report sets forth a Framework for overcoming these obstacles and developing a national health information infrastructure.
Framework for Strategic Action
The Framework identifies four major goals for the adoption for health care technology and describes strategies to achieve each of these goals.
Informing clinical practice. This goal is focused on ensuring that health care providers obtain and use electronic health records systems. Three key strategies are: 1) incentivize the adoption of electronic health records systems; 2) reduce the risk of investing in electronic health records; and 3) promote the use of electronic health records in rural and underserved areas. Adoption
incentives being considered include: regional grants and contracts; low-rate loans; revision of federal physician self-referral and anti-kickback protections; paying for the use of electronic health records; and pay-for-performance mechanisms whereby clinicians are paid to improve outcomes that are linked to quality
management. Proposed means to reduce the risk to providers of investing in electronic health records include: use of institutions and agents to support physicians in their purchasing decisions; technical assistance from public and private organizations with the challenges of implementation and workflow change; and
development of a certification process for electronic health records products. Technology transfer and other support efforts from the Department of Veterans’ Affairs (“VA”), the Department of
Defense (“DoD”) and the Indian Health Service (“IHS”) are identified as methods of addressing the barriers to adoption in rural and underserved areas.
Interconnect clinicians. This goal seeks to establish the
interoperable infrastructure that will allow health care information to move with patients among points of care and helps clinicians access that information when clinical and treatment decisions are being made. Three key strategies are: 1) foster the work of regional health information organizations; 2) develop a national health information network; and 3) coordinate federal health information systems. Regional health information organizations, the entities that exercise local leadership and governance of health information exchanges, require a common approach to formation and operation. Federal financing and either regulatory oversight or non-governmental accreditation are being considered. Steps to develop a national health information network include:
and operate the national health information network; creation of nonproprietary, broadly available intercommunication tools;
adoption of interoperability standards and policies; and technology transfer from government systems. Efforts to promote
coordination among federal health information systems include: developing a common information architecture that will enable collaboration and data sharing within the federal government and with states and private entities; and creating uniform security and data integrity standards.
Personalize care. The Framework calls for ensuring that
individuals have the information to manage their own health and knowledgably participate in their own health care decisions. Three strategies identified for achieving this goal are: 1) encourage the use of personal health records; 2) enhance informed consumer choice; and 3) promote the use of telehealth systems. Proposals to encourage the use of personal health records include:
development of standards and policies to ensure that the personal electronic health records contain appropriate and useful
information from an individual’s prior, hand-written health records and other sources; dissemination of health information and
knowledge through federal websites; and the creation of a Medicare Beneficiary Portal to provide claims information and guidance regarding preventative care services. Efforts being considered to promote consumer choice focus on publishing information on health care provider performance. Proposed telehealth promotion mechanisms include: health plan reimbursement for the practice of telemedicine; funding for
telemedicine programs; and coordinating telehealth policies across federal agencies.
Improve population health. Improving population health is
focused primarily on the responsible and productive use of shared clinical data. The three strategies identified to achieve this goal are: 1) unify the public health surveillance architectures; 2) streamline quality and health status monitoring; and 3) accelerate clinical research and the dissemination of new discoveries into clinical practice.
Players on the National Stage
In releasing the Health Information Technology Report, Secretary Thompson claimed that the Framework would transform the practice of medicine, improving the efficiency, quality and cost of health care delivery. He emphasized that other industries, including banking and publishing, have flourished through the adoption of interoperable computer technologies. The
Secretary stated that the healthcare industry was at a tipping point, and that through the public-private collaboration described in the Framework there would be a national electronic health records system within the next ten years.
The heads of agencies throughout HHS affirmed their commitment to the Framework and described their agencies’ efforts to advance the use of health information technology, including electronic health records. Mark McClellan, Administrator for the Centers for Medicare and Medicaid Services (“CMS”), stated that CMS would release regulations to implement standards for e-prescribing later this year and would conduct demonstrations on financial incentives to promote the adoption of electronic health records including “pay-for performance.” Elias Zerhouni, Director of the National Institutes of Health (“NIH”), described the creation of the National Centers for Bioinformatics at NIH to coordinate federally funded efforts at software development and its role in developing standard vocabularies and format for clinical trials data. Julie Gerberding, Director of the Centers for Disease Control (“CDC”), described her agency’s efforts to develop tools to electronically detect health threats. The Agency for Healthcare Research & Quality (“AHRQ”) touted its collaboration with the private sector to develop standardized metrics to benchmark progress in the
adoption of health information technology. The AHRQ and the Health Resources and Services Administration (“HRSA”) each described its role in coordinating contracts and grants to finance the implementation of health technology and the development of best practices.
Other federal agencies joined with HHS in expressing their
willingness to develop and share best practices to advance health information technology. For example, Office of Personnel
Management (“OPM”), the federal agency responsible for overseeing the health benefits for federal employees, is
incorporating performance goals and financial incentives into its contracting with health plans and providers, and it stated that its efforts could serve as a model for private employers. Together, these agencies articulated the unified commitment of the federal government to use the Framework to promote health information technology.
Representatives of private industry, including some of the nation’s largest technology companies, expressed a similar dedication to collaborative efforts to advance the Framework. Speakers included the leadership of Cisco Systems, McKesson, Cerner, Computer Sciences Corporation, IBM, Siemens, and GE
Healthcare. They praised the government leadership in promoting the adoption of health information technology. They emphasized the need for interoperability, including open standards and shared intellectual property. Technology leaders stated that they will work with the government to develop the business case for investment in the electronic health records systems. Financial incentives to health care providers, with a focus on small physicians offices, was cited as the cornerstone to the rapid development of the national health information infrastructure.
Next Steps
• Secretary Thompson convened a Health Information
Technology Leadership Panel of industry officials and health care experts to explore the costs and benefits of health
information technology and evaluate the urgency of investment in these tools.
• The National Alliance for Health Care Information Technology Advancement, a coalition of health care purchasers and payers representing almost 200 million covered persons, is developing action items its members will take to give health care providers incentives to adopt health information technology.
• On July 21, 2004, Senator Judd Gregg, Chair of the Health, Education, Labor and Pensions Committee, introduced legislation (S. 2710) to implement some of the
recommendations of the Framework. Among its provisions, S. 2710 would authorize $100 million per year for five years to finance grants and loan guarantees to facilitate the purchase and adoption of health information technology.
These efforts suggest that both the public and private sectors may be on the verge of large-scale investment in the national health information infrastructure.
For more information, please contact the following Hogan & Hartson attorney[s] or any other attorney in the firm with whom you have an existing relationship.
Marcy Wilder Washington, DC 202/637-5729 Donna A. Boswell Washington, DC 202/637-5814
This Update is for informational purposes only and is not intended as basis for decisions in specific situations. This information is not intended to create, and receipt of it does not constitute, a lawyer-client relationship.
Copyright 2005 Hogan & Hartson LLP. All rights reserved.
