Now Reading: Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field

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:

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, ). 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.


February 4, 2008

Dear Dr. Eytan:

I read with great interest your blog on electronic personal health records and thought you would find MMR of interest. MMR has contracts with organizations covering more than 30 million lives to provide our services.

Contrasting MMR to other popular EMR products, MMR is delivering the most user-friendly, convenient and versatile web-based Personal Health Record available today. Using our proprietary patent pending technologies, complete patient information including actual lab test results, radiology reports and images, progress notes and all of a patient’s charts can be uploaded or faxed with annotated voice notes and comments directly into the user’s password-secured account. Users do not need to install any special software or use any special hardware to use our service.

MMR also has integrated other advanced features, such as multilingual translation, a drug interaction database of more than 20,000 medications, calendaring for prescription refills and doctor appointments, and private voicemail for a doctor’s message and other personal uses.

There also is a special “Emergency Log-In” feature that allows a doctor to access a user’s account to view their most important medical information in the event of a medical emergency. To ensure individual privacy, specific data, such as prescriptions, allergies, blood type and copies of actual medical files or images, are pre-selected by the user for inclusion in the online read-only Emergency Folder.

In addition, MMR also includes an online ESafeDeposit Box feature that enables users to securely store any important document in a virtual “lock box” and access them anytime from anywhere using an Internet-connected computer or PDA. These documents can include Advanced Directives, Wills, insurance policies, birth certificates, photos of Family, Pets and Property, and more. MMR is clearly one of the most complete user-friendly Personal Health Records available today (I can send you a comparison chart).

I would encourage you to visit MMR and set up a complimentary account. Simply go to and sign up using registration code MMRBLOG. I would be interested in your experience and hope that you will include us in any further discussions of Personal Health Records. I could also send you more information by email or snail mail (the latter allows me to send a bit more than I’d want to clog your email with). Recently, we sent out a release about MMR Pro, which will better enable physicians to put patient records into secure, online accounts.


Scott S. Smith

Director of Public Relations

11000 Santa Monica Blvd. #430

Los Angeles CA 90067


Ext 123 (Cell: 310/254-4051)

[email protected]

Scott is allowing his info to be published here, and as a trial I will allow this info up here to add to the conversation about enhancing patient access to information, without any promotion of third party products.

If you have comments about any of this, fire away.

Ted Eytan, MD