WASHINGTON — Seeking to shift the debate from how to adopt electronic health records (EHRs) to how health-IT actually can improve care and save lives, a coalition of health-IT advocates hope a new document can serve as a roadmap and timetable for health care providers, payers, vendors, government entities, and yes, consumers, to follow.
“Most landmark reports have talked about health-IT just for the sake of health-IT,” says Jeffrey Kang, senior vice president and chief medical officer of health insurer Cigna, and president of the eHealth Initiative Foundation. A new “blueprint” from the foundation’s parent organization, the eHealth Initiative (eHI), also considers quality and outcomes, according to Kang.
The blueprint, free to the public at www.ehealthinitiative.org/blueprint, represents a “shared vision … a set of common principles and actions for improving health care and health through health care IT,” rather than an IT implementation guide, says eHI’s CEO, Janet Marchibroda. “It’s our hope that the blueprint will inform those deliberations as they move forward,” in federal and state government and in the private sector, Marchibroda adds.
In developing the blueprint, eHI brought together nearly 200 stakeholders from across the health care spectrum in an attempt to reach consensus in five main areas: Engaging consumers; transforming care delivery at the point of care; improving population health, including public health surveillance and the elimination of health disparities between communities; aligning financial and other incentives; and managing privacy, security, and confidentiality of health care data.
The coalition was able to agree in the first three areas. “We achieved consensus on many, but some need further discussion,” says Christine Bechtel, eHI’s vice president of public policy and government relations. Left unresolved are how to design and implement financial incentives and how to enable health information exchange without compromising patient confidentiality.
“Everyone agreed hands-down that consumers have to be in contol,” Bechtel says. The dispute is over how to balance privacy and security needs with the benefits of data aggregation for assessment and research.
Also, participants continue to struggle with quantifying patient-safety gains from IT, a necessary step in aligning payment with quality incentives, according to eHI. “We don’t have good evidence on that. We don’t have incontrovertible, solid evidence about who benefits,” Bechtel says.
In a speech here last week to eHI’s annual meeting, national health-IT czar Robert Kolodner praised the consumer focused components of both this blueprint and of a personal health records program announced days earlier by the American Health Information Management Association (AHIMA), but cautioned of a tough road ahead. (See story.)
“It’s going to take some coordination,” Kolodner says of the national drive to bring interoperable electronic health records to the majority of Americans by 2014, with an eye toward improving health outcomes and reducing costs. But he also says the health care industry isn’t quite ready for such a radical realignment.
“If all incentives were aligned today, we’d all be in big trouble,” Kolodner says, citing a shortage of health care workers trained in IT. “Let’s get the public involved to recognize that their health is on the line,” he says.
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