The gains derived from deploying healthcare IT could be dramatic, but difficult to achieve, say experts in the March/April issue of Health Affairs.
The journal asked experts from around the country how the $19 billion healthcare IT piece of the economic stimulus package cold affect healthcare delivery in the nation. Health Affairs is a peer-reviewed health policy journal published bimonthly by Project HOPE.
In the March/April issue and a series of separate papers the authors, which include former healthcare IT chief David Brailer, Harvard Medical School and Beth Israel Deaconess CIO John Halamka and Catherine Chen and colleagues at Kaiser Permanente, explore the benefits, challenges and risks ahead as the country embarks on a transformation of the healthcare system.
Patients go for e-visits
Chen and her colleagues at Kaiser Permanente say a comprehensive electronic health record could transform healthcare delivery - and, in particular, help address the increasing burden on primary care physicians.
The system, which has been introduced throughout Kaiser Permanente, was rolled out in Hawaii in 2004. The Kaiser system allows physicians and patients to communicate via secure e-mail messaging in lieu of a traditional office visit. Once adopted, the e-visits resulted in a more than 25 percent drop in office visits.
"Electronic health records have the potential to make care more efficient," said Chen, manager for national clinical systems planning and consulting at Kaiser Permanente. "However, few providers will adopt such technology unless public and private policies reward providers for care via online visits. Consumer preference for more convenient methods of care, where appropriate, also needs to be taken into account."
Kaiser Permanente, a health plan that covers an estimated 8.7 million patients in eight regions, has a health IT system that allows clinicians to document visits in the inpatient and outpatient settings, provides clinical decision support and allows for instant connectivity to labs, pharmacy, radiology and other services.
Physicians can contact patients electronically, order consultations, laboratory and other diagnostic work and send prescriptions directly to the pharmacy. The system also allows for secure messaging between patients and providers and for messaging between providers that is automatically incorporated into patients' records.
Kaiser researchers also reviewed the system's effects on quality and patient satisfaction. Overall quality remained unchanged. KP Hawaii member satisfaction surveys also remained essentially unchanged. The researchers did not examine the system's effect on net efficiency or costs.
Consumers flock to Kaiser Web site
In a related paper, Kaiser Permanente's Anna-Lisa Silvestre and co-authors detailed consumer enthusiasm for the health system's member Web site and online health services to exchange e-mail with physicians, schedule appointments, view records, get test results and manage benefits, among other activities. As of July 2008, 2.4 million KP members had registered to access the site's secure features. On average, 58,734 KP members register to use the site each month.
Registrations began to increase rapidly in 2006, when personal health records became widely available. Web-site use was not limited to the wealthy and educated – half of the survey sample reported household incomes of less than $75,000 annually, and nearly half did not have a college degree.
Privacy, security debates
Several papers in the March-April issue tackle the debates over health information privacy and offer potential solutions:
• Deven McGraw of the Center for Democracy and Technology and colleagues describe a proposed privacy framework developed by the Markle Foundation's Connecting for Health initiative that would incorporate key privacy principles. These include specific network design features and oversight mechanisms to establish greater public trust in health IT.
• Linda Dimitropoulos and Stephanie Rizk of RTI International share lessons from a multi-state project focused on developing common privacy and security practices in states. The project is part of an effort to reduce the variation in privacy and security laws and practices among states that impede electronic health information exchange (HIE).
• Micky Tripathi and colleagues detail how the Massachusetts eHealth Collaborative, a communitywide pilot project to encourage the use of EHRs and HIE among healthcare providers, has engaged patients in developing policies through which they consent to having their health information shared. The collaborative has more than a 90 percent opt-in rate among patients to participate in widespread electronic data sharing.
Other papers in the issue offer arguments for and against a new national privacy standard.
Separately, Health Affairs has released online articles that offer perspectives on health IT and the recently enacted American Recovery and Reinvestment Act of 2009:
• David Brailer, the former national coordinator for healthcare information technology, shares lessons from healthcare IT efforts in the Bush administration and offers guidance for the current administration. Although Congress' move to allocate $19 billion for the adoption of EHRs is a step in the right direction, Brailer highlights problems that could present roadblocks to data exchange, increase costs and reinforce resistance to patient-centered care.
• John Halamka, chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center, offers five guiding principles for speeding adoption of EHRs that build on previous work and avoid misspending economic stimulus and recovery funds.
• Mark Frisse of Vanderbilt University writes that an opportunity will be missed if healthcare IT simply automates a broken system.
• Ticia Gerber of Manatt Health Solutions highlights the common threads in national and global healthcare IT debates, including the need for strong stakeholder engagement, funding and donor coordination, and challenges for standards and interoperability.
