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.

Chicago can get really really cold.

I found this out when I braved what I would call a challenging travel experience, along with several other HIT experts, to attend a new Joint Commission Public Policy Roundtable, addressing the creation of a nationally interconnected Health Information Technology System.

It was both worth the effort and I left welcoming the Joint Commission’s leadership and support. And since I originally hail from Phoenix, Arizona, I am apt to exaggerate the harshness of winter travel, anyway.

If you are not familiar with The Joint Commission, it is an organization with an important mission and positioned to “Help Health Care Organizations Help Patients.” I’ve encountered The Joint Commission’s work in my Informatics leadership role and it has definitely shaped improvements in quality, safety, and affordability of care. There is a lot of respect there.

Convening a roundtable like this is part of a larger process that includes an expert panel, the creation of a white paper, and conferences to influence policy. This roundtable covered a nice cross section of the HIT landscape, with sections on:

• Realizing the Benefits of HIT
• Creating Incentives to Spur HIT Adoption
• Overcoming Implementation Barriers
• Achieving Interoperability

Further, the attendees represented a core group of some of the most dedicated individuals to furthering a better health care system through technology. What was useful for me was the fact that most of the experts talking about HIT are from institutions which have viable PHR’s, or are working to build them. These are groups that understand the realistic promise in this area.

The most striking pieces of data to me were around adoption of HIT by physician practices, still in a range that we find disheartening - 14% by one definition, and by another, even lower at 4%. While patient centered HIT doesn’t require an EHR, it’s certainly easier to support it with an EHR. There was also an excellent overview by Dr. David Blumenthal from Massachusetts General Hospital of the different factors supportive of HIT adoption in different countries - everything from public support, to the presence of certified products, to peer support.

In terms of input I provided, it was to keep the patient at the center of the discussions, to promote patient adoption of HIT as well as physician adoption of HIT, and that transformation using HIT is really an element of an organization’s continuous improvement strategy. HIT doesn’t make this happen, but it makes improvement happen much more beneficially.

How did I leave this roundtable? Overall, very enthusiastically.

On the way to the airport from the meeting, I was able to share a ride with Don Detmer, MD, who is to me something of an Informatics hero, and a person who I believe has even more energy than I do. Don talked about the idea that there is a role for everyone to play, and we shouldn’t get seduced by the concept that there is one stakeholder responsible for forward movement. This is really important for us on the PCHIT initiative as we take our experience and put together some key attributes in our Personas work (coming soon). The other thing he did was recount some of his experience to me, which had a common thread throughout - the work of an inspired leader changed attitudes and then behavior to a different status quo.

I think we should look forward to the publication of the Joint Commission’s white paper on Creating a Nationally Interconnected Health Information Technology System and I am glad that this organization is applying resources to supporting our health system in this way.