Realizing the Full Potential of Health IT to Improve Healthcare for Americans: Yet Another Path Forward?

A ground-shaking (yes, I said shaking, not breaking) report was published this week that examines how health IT could improve the quality of healthcare and reduce its cost, and considers whether existing federal health IT efforts are optimized for these goals. The report was prepared by the President’s Council of Advisors on Science and Technology (PCAST), which is an advisory group of the nation’s leading scientists and engineers, appointed by the President to augment the science and technology advice otherwise available to him.

Not surprisingly, PCAST has concluded that information technology can help realize a number of important benefits, including:

• improved access to patient data;
• streamlined monitoring of public health patterns and trends;
• an enhanced ability to conduct clinical trials of new diagnostic methods and treatments; and
• the creation of new high-technology markets and jobs.

What I found most interesting is that PCAST has also concluded that “…to achieve these objectives, it is crucial that the Federal Government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy.”

More specifically, PCAST recommends that “…the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) develop guidelines to spur adoption of such a language and to facilitate a transition from traditional electronic health records to the use of healthcare data tagged with privacy and security specifications.”

So what is so ‘ground shaking’ about this report? I concur that it offers a realistic assessment of health IT today: its current state, barriers and challenges. And it is quick to point out that the ability to integrate electronic health information about a patient and exchange it among clinical providers remains the exception, rather than the rule.

But, the report goes on to state that rapid progress can only be made through technology choices that open up markets to competition and innovation. And further, it indicates this requires a new universal exchange language for healthcare information as well as a new digital infrastructure for locating patient records while strictly ensuring patient privacy. It is this assessment with which I beg to differ.

Over the past decade, the health IT community has been working collaboratively and diligently on a number of standards-based approaches to health information exchange that address optimal privacy and security needs; these innovative approaches are advancing via pilots, demonstrations and regional health information exchanges. And many of these capabilities are being adopted in healthcare institutions today.

The Administration and Congress have recently made major investments through HITECH to promote the adoption of electronic health systems and to ensure that the full promise of health IT is realized. The programs stemming from these investments are just now being launched and publicized. And while some may describe the overall progress of these collective efforts as slow, we are indeed steadily advancing towards the adoption of interoperable solutions, built on a consensus-based foundation of standards and implementation guides, many that are available today to achieve the goals of PCAST.

While I appreciate that these issues are complex and rapid progress is necessary to achieve a nationwide health IT infrastructure, I would suggest if we continually change direction and fail to leverage the best of existing efforts, we will never reach the optimal end state.

It is laudable to envision the future, lay out a roadmap and suggest a magic bullet. But if we don’t place a stake in the ground and build on top of an existing foundation, not only will we NOT make progress, but we also risk losing the commitment and energy of the key stakeholders who, like us, are waiting to realize this vision.

ONC has published a request for comments regarding the PCAST report and its implications for the nation’s health IT agenda. My blogger colleagues John Halamka and Keith Boone have also shared their thoughts.

I, too, welcome your thoughts on the PCAST recommendations and to the commentary in this blog. Perhaps together we can come up with some collective wisdom that will help avoid creating yet another path forward.