Health Care News, December 1, 2007

A growing number of initiatives within the private sector, among industry groups, and at the state level to promote and adopt health information technology (HIT) have some analysts suggesting federal efforts have been less effective than developments driven by consumers, businesses, and nonprofits.

It is widely believed that HIT has the potential to make it easier for health care providers and consumers to collect and share data. Standardized, comprehensive records are expected to save the industry money because physicians would not duplicate tests and would have better information with which to make treatment decisions.

With easier access to their own medical data, consumers could better manage their health and health care services. Also, some of the billions of dollars spent annually to keep track of paper records could be saved or redirected.

That's the vision the private health care sector has been working on for more than a decade--and one the federal government signed on to in 2004 when President George W. Bush created the position of National Coordinator for Health Information Technology.

Private Firms, Nonprofits Leading

HIT is proving complicated and controversial, however, principally because of the tension among health care consumers, who desire confidentiality and control of their records, and physicians, hospitals, and insurers, who want access to those records.

In an attempt to address that tension, private companies and nonprofit agencies are forming voluntary associations, known as Regional Health Information Organizations (RHIOs), that are far ahead of the federal government in using electronic networks to exchange health data.

According to information compiled by the Health Information Management Systems Society (HIMSS), 391 RHIOs are active in the United States, and more are planned. New York leads with 42 RHIOs, followed by Minnesota with 38, California with 31, and Florida with 20.

RHIOs take different forms. One might incorporate two entities sharing full health records information, whereas another might encompass a group of community health care providers sharing a specific type of medical data, such as lab results. All emphasize interoperability and security.

Mandates Unnecessary

HIMSS, which represents 20,000 heath information technology professionals, calls such RHIOs the building blocks of a National Health Information Network (NHIN), over which health care providers, payers, and consumers could exchange records. This is the network the federal government is supposed to facilitate by 2014 through the Office of the National Coordinator for HIT.

In her paper "America's Consumers Will Beat Government to (Health) IT," Diana M. Ernst, health care studies public policy fellow for the Pacific Research Institute, notes, "America's private companies and employers are running with IT, and without government mandates, but with the superior goal of satisfying patients."

Meanwhile, Ernst observes, the federal government spent $900 million in 2004 launching its HIT initiative and has spent $600 million since, mainly on evaluations of various products, coordination, and privacy requirements associated with HIT.

In addition, H.R. 4157, a bill designed to promote HIT that now appears unlikely to pass, would have cost the private sector more than $1 billion to implement, according to the Congressional Budget Office.

States, Private Sector Partner

Nearly every state has at least one HIT initiative under way, many undertaken in partnership with private companies. In the most recent news, Kentucky and New Hampshire announced separately their progress in encouraging "e-prescriptions," by which physicians transmit prescriptions electronically to a patient's pharmacy.

In New Hampshire, the technology infrastructure for e-prescribing has been supplied by RxHub and SureScripts. In addition, Anthem Blue Cross & Blue Shield and the New Hampshire Citizens Health Initiative, a public-private partnership, are offering free software, a free mobile pocket PC, and a discounted wireless telecommunications plan to physicians not affiliated with a larger group practice or hospital so they can easily participate in e-prescribing.

Kentucky has created the Kentucky e-Health Corporation, designed to "improve collaboration between the public and private sectors" in meeting Gov. Ernie Fletcher's (R) goal of having electronic health data available to the state's residents by 2011.

Through HIMSS and a variety of workgroups within the American Hospital Association and other organizations, the health care industry has been working for years on data standards and interoperability.

"Thriving incentives for voluntary enterprise in health IT are already expanding outside of government edict and are likely to operate more effectively than blanket, government-issued programs, including heavy-handed federal legislation on the private sector," writes Ernst.

Sharon J. Watson (sjwatson44@comcast.net) writes from Sugar Land, Texas.