Experts Urge Congress to Move Ahead With HIT Carefully

Congress should invest in health information technology, or HIT, as part of an economic stimulus package by providing loans and grants to further the adoption of HIT systems, according to witnesses who testified before the Senate Health, Education, Labor and Pensions, or HELP, Committee here on Jan. 15. But the stimulus also should be used as a first step in incorporating HIT into the broader framework of health care reform, those experts added.

"I would really focus the near-term stimulus on leveraging the existing data assets that are out there," said Peter Neupert, corporate vice president of the Health Solutions Group at Microsoft and one of six witnesses to testify before the committee.

Neupert said the $20 billion set aside for HIT in the stimulus package proposed by the House could be used in part to improve the interoperability of current systems and to facilitate the ability of health care providers to share certain types of patient data, such as prescriptions and lab results. These actions, in turn, would lead to immediate improvements in health care, according to Neupert.

Many HIT systems are closed and, thus, lack interoperability, making it impossible for health care providers to share patient data electronically. "Getting those (technology systems) open and sharing is an important first step," said Neupert. "Then, we can do the hard work of thinking holistically about how to reform the (health care) system."

Mary Grealy, J.D., president of the Healthcare Leadership Council, said investing in HIT through the economic stimulus package would be a "tremendous catalyst" in moving adoption of this technology forward. But she added that the economic stimulus package first should serve as a down payment on HIT by providing funds to health care providers to help them invest in systems so that they can take part "in the HIT revolution."

"Implementation is the first step," agreed John Cochran, M.D., executive director of the Permanente Federation, the national umbrella organization for the regional Permanente Medical Groups. He added, however, that Congress should identify what it wants in return for its investment in HIT in the stimulus package.

"The real objective of HIT in the economic stimulus package should not be technology, but rather to improve safety, quality and efficiency," Cochran said.

Sen. Barbara Mikulski, D-Md., who chaired the hearing, said Congress wants to foster the development of a user-friendly national HIT system that is patient-centered, patient-secure and interoperable. Mikulski noted, however, that she is skeptical about Congress' ability to accomplish that goal, explaining that she has served on other Senate committees that moved quickly ahead on projects with "unbelievably good intentions and the will of the American people behind us."

"We threw a lot of money at stuff, and we ended up with boondoggle," she said. "I can't go there again, and we cannot afford to go there again. We cannot afford to waste time on a fool's journey or waste money. We just don't have either one."

Mikulski's words resonated with the six witnesses, who advised Congress to proceed carefully with HIT. Valerie Melvin, director of human capital and management information systems at the Government Accountability Office, said, for example, that HIT is "not something you want to do very quickly." By taking an incremental approach, Congress would have the opportunity to step back and assess what is working and what is not working and to adjust accordingly, she said.

Cochran told the HELP Committee that implementing HIT in a clinical setting is disruptive. "You should expect a reduction in productivity for the first few months and should not expect immediate cost savings," he said. "You have to go fast to go slow in many ways because the initial stages of implementation must be well thought out."

Cochran also said patience and persistence are key factors when implementing an HIT system. "And physician leadership is critical," he added.

The witnesses were quick to point out the benefits of HIT, saying that it can result in enhanced care coordination and improved health outcomes at a lower cost.

For example, the NorthShore University HealthSystem in Evanston, Ill., implemented an electronic health records system in 2003. As a result, more than 50,000 NorthShore patients now can use the Internet to schedule appointments, refill prescriptions and communicate with their physicians, according to Grealy.

"Thanks to their ability to see whether patients are receiving conflicting medicines, they have reduced medication error rates by 80 percent," she said.

At the same time, NorthShore officials are able to identify patients infected with methicillin-resistant Staphylococcus aureus, or MRSA, upon admission faster and, thus, can manage those patients more effectively, resulting in a 70 percent drop in overall MRSA infection rates.

"It is no wonder that HHS estimates savings as high as $400 billion over a five-year period if we implement a national health information network," said Grealy.

The witnesses stressed, however, that HIT is not a silver bullet, and it is only one piece of a larger health care system. HIT is a perfect example of an initiative that can result in large investments without yielding any returns if it is not tied to improvements in the overall delivery of health care and the way health care is paid for, said Cochran.

It is critical, he said, to "determine how to translate the data collected within the system into useful information that will deliver value. It is not just about digitizing the visit. It's about using the data from that visit and other sources to inform and, ultimately, to transform care delivery."