Bruce Merlin Fried, Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field – CHCF.org (California Healthcare Foundation).

The highly respected California Healthcare Foundation has been putting out an impressive array of topical work in the health information technology lately, and I thought this one deserved its own post.

The piece, Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field, is a summary of activities to date in the United States’ Health Information Technology Adoption Initiative along with interviews of nearly two dozen leaders and experts in the HIT community about progress to date. If, like me, you eagerly read the initial “Decade of Health Information Technology” document when it came out in 2004 and were filled with hope, this piece is definitely for you. Even if you didn’t read the initial document, this piece will get you up to speed, because it describes the four cornerstones of the HIT initiative and talks about what has happened since.

And how’s the news? Mixed. It appears that success has been achieved in creating awareness globally, and in the cornerstone of certifying electronic health records (I should mention here that I am on one of the Foundation Workgroups for the Certification Commission for Health Information Technology).

I am studying a lot of LEAN Hoshin Kanri principles right now, so visual rating systems are on my mind. If I were therefore going to create a visual for the cornerstones, based on what I read here, I would put a Red light (danger) next to Nationwide Health Information Network, Red light next to adopting interoperability standards, Green light next to certifying EHRs, and Yellow light next to Reconciling laws.

There isn’t a lot of clarity about what we mean by HIT, as the paper highlights. Does this mean that consumers/patients will use an EHR because they have access to a PHR? We can’t know because we aren’t there yet. That’s the bad news.

There’s some good news, such as this nice quote from Carolyn Clancy, MD, of AHRQ:

If there was a tipping point here, my guess is it was probably Kaiser [Permanente] turning to Epic [Systems Corporation]. I think what a lot of people are beginning to see is that these investments can actually change the nature of health care to a series of transactions that are far more proactive, that can happen right now even without payment reform.

On the not so good side, there is more debate about the role of interoperability as a priority, or even as a separate cornerstone. From what I read, I think this article gets tagged in my growing collection of what I call “HIT_before_HIE,” which are the voices of a growing number of experts who question the value of pursuing interoperability before operability. Feel free to peruse the collection in the link cloud I have set up on the topic:

http://del.icio.us/tedeytan/HIT_before_HIE

What has my own experience been during this time? Well, in the time period from 2004-2007, I was involved in implementing one of the world’s largest personal health records, and a successful statewide electronic health record, in an organization that shares a lot of the “ideal” characteristics of care model that Kaiser Permanente does. I have seen that it can be done. I was also involved in the setting up of a Hoshin Kanri system to guide strategy deployment, to make sure that we got the right things done in maintaining and further developing our HIT capabilities.

In my sabbatical experience, I have seen that the desire is as strong as it is within the walls of my organization, but it is not happening at the same pace. This is why I take works like this seriously – the results I see in my on the ground work corroborate what is said here.

In addition, I find some congruence between the opinions of the experts in the article and my experience at the recent Joint Commission Roundtable in Chicago, where I learned about the paths to success in HIT in peer countries. Each has a strong public commitment to HIT.

There is more to be done. One of the comments I made in Chicago was that 4-14 % adoption for EHRs in small practices is too low for 2008. It’s too low for 2005. I wonder about prioritizing EHR with PHR adoption and studying work to quantify the value of incentives that has already been done (see Roger Taylor et al., “Promoting Health Information Technology: Is There A Case For More-Aggressive Government Action?,” Health Aff 24, no. 5 (September 1, 2005): 1234-1245, http://content.healthaffairs.org/cgi/content/abstract/24/5/1234. ). I also wonder about applying LEAN methodology to the strategy and deployment of HIT policy by our government. I think a Hoshin Kanri approach would make a difference by establishing focus and a sustained deployment plan.

Thanks for reading my thoughts. I welcome your comments.