The Hit Record
When it comes to using technology to streamline the health care system, the biggest buzz is about digitizing individuals' health records--putting them in a standardized format and connecting them via the Web.
When it comes to using technology to streamline the health care system, the biggest buzz is about digitizing individuals' health records--putting them in a standardized format and connecting them via the Web. Rhode Island Governor Donald Carcieri personalizes the need for such a system: If he got hit by a bus, he points out, no one at the emergency room would know his medical history and that could delay treatment or result in unnecessary tests and treatments.
The present health care system is bound to an infrastructure of doctors' handwritten notes stuffed into patients' manila folders that sit on shelves in doctors' offices. The U.S. Department of Health and Human Services has been asking health care organizations to work jointly toward a national health information network that would turn the manila folders into digital files that could be accessed online. So far, it's mostly acronyms that are taking off: EHRs, RHIOs, HIEs, HIT. Those stand for electronic health records (the digitized manila folders), regional health information organizations (umbrella organizations to oversee development and implementation), health information exchanges and health information technology.
With federal funding for the efforts floundering and few providers willing to take on the fiscal burden of converting their manila envelopes to EHRs--especially without national standards for interoperable technology--states are trying to lead the way as best they can. The motivation is, in part, fiscal necessity. Health care is the number one public policy issue, Carcieri says. Rhode Island revenues, for instance, are growing at 4 to 5 percent while the chunk of the budget dedicated to Medicaid, the state's major health care program, is increasing at 10 to 12 percent. Something has to slow down the latter.
Carcieri sees smaller states such as his as the ideal laboratories for experimentation in lowering some costs by connecting medical offices, hospitals, insurers and other providers. With its concise geography and only two major insurers and two major hospitals, Rhode Island, its governor points out, has certain advantages in moving forward that larger states with more complex systems don't have.
To get the experiment rolling, Carcieri's administration created the position of health commissioner less than two years ago to look at regulatory issues and be the point person on health. So far, the commission has set six IT objectives. At the top of the list--and an effort that is well underway--is an electronic prescription network. By 2007, the state aims to have 75 percent of prescriptions transmitted electronically and have a system set up in which providers are able to use a data exchange to look at lab data history. The state will also work on increasing electronic data transfer systems and, with the Rhode Island Quality Institute, manage the statewide health exchange. Rhode Island is one of nine states that are participating in a U.S. DHHS-sponsored project to identify best practices for state- level RHIOs. Rhode Island sees RHIOs as being in charge of running the health information exchange and establishing such things as governance rules and financing.
There are many more HIT challenges to tackle--challenges that lie beyond the boundaries of any one state. There's the issue of compatible technologies and another one about network sustainability. No health information exchange projects studied by Avalere Health, an advisory company on health care business strategy and public policy, has come up with a workable business or financial model for health information exchanges.
But hope springs eternal. Kentucky Governor Ernie Fletcher, who also sees his state as a laboratory for developing electronic health records and other IT health solutions, dreams big. "In five years," he says, "we'll speak about paperwork clipboards with the same nostalgia we express about the eight-track tape player."