HHS Issues Report Outlining Steps to Build Health Information Infrastructure

July 21, 2004 -- HHS Secretary Tommy G. Thompson today released the first outline of a 10-year plan to transform the delivery of health care by building a new health information infrastructure, including electronic health records and a new network to link health records nationwide. At the same time, he announced a number of new action steps to help advance health information technology immediately

"America needs to move much faster to adopt information technology in our health care system," Secretary Thompson said as he released the action report ordered by President Bush. "Electronic health information will provide a quantum leap in patient power, doctor power, and effective health care. We can't wait any longer."

The plan, prepared by the new National Coordinator for Health Information Technology, David J. Brailer, MD, PhD, lays out the broad steps needed to achieve always-current, always-available electronic health records (EHR) for Americans. EHR systems would also enable physicians and other health professionals to electronically tap into a wealth of treatment information as they care for patients. The report was released in Washington, DC, at a Secretarial Summit on Health Information Technology bringing together the nation's technology and health leaders.

"Health information technology can improve quality of care and reduce medical errors, even as it lowers administrative costs," Secretary Thompson said. "It has the potential to produce savings of 10 percent of our total annual spending on health care, even as it improves care for patients and provides new support for health care professionals." At the same time, security and privacy of electronic medical records would be improved over protections of paper-based records, Secretary Thompson said. And health information technology also offers much greater access and control of health records by consumers themselves.

Secretary Thompson announced he would appoint a special Leadership Panel to assess total costs and benefits of health information technology and report to him by fall. He also announced efforts underway to develop private sector certification for health information technology products. And he said HHS will begin reviewing the feasibility of a private sector consortium to plan and develop a new nationwide network for health information.

In addition, Secretary Thompson announced Medicare plans to create an Internet portal allowing beneficiaries to access their personal Medicare information. And he said Medicare will accelerate regulations for e-prescribing of drugs in order to quickly disseminate common standards. He also announced new grants to help develop information exchanges in nine communities, adding that $50 million more in seed funding will be provided to five states this fall, with plans doubling the investment in 2005.

President Bush in April called for electronic health records for most Americans within 10 years. In an executive order, he created the new Office of the National Coordinator for Health Information Technology, and in May, Dr. David J. Brailer, was appointed to the new position.

"President Bush has identified health information technology as one of the most important technology areas for America's future," Dr. Brailer said. "This report lays down a foundation for achieving this national priority and moves us from a period of discussion into a period of rapid action."

Goals and Strategies

The report, "The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care," says federal leadership can help hasten efforts to be carried out by the private sector. The report identifies four major goals, with strategic action areas for each:

• Goal 1 – "Inform Clinical Practice:" Bringing information tools to the point of care, especially by investing in EHR systems in physician offices and hospitals.
• Goal 2 – "Interconnect Clinicians:" Building an interoperable health information infrastructure, so that records follow the patient and clinicians have access to critical health care information when treatment decisions are being made.
• Goal 3 – "Personalize Care:" Using health information technology to give consumers more access and involvement in health decisions.
• Goal 4 – "Improve Population Health:" Expanding capacity for public health monitoring, quality of care measurement, and bringing research advances more quickly into medical practice.

In addition, the report identifies potential policy options for providing incentives for EHR adoption. The health sector has been slow to invest in EHRs, with only 13 percent of hospitals reporting they had the systems in 2002, and 14 to 28 percent of physicians' practices. Some incentive options to be reviewed include:

• regional grants and contracts to stimulate EHRs and community information exchange systems;
• improving availability of low-rate loans for EHR adoption;
• updating federal rules on physician self-referral that may unintentionally restrict investment and networks;
• using Medicare reimbursement to reward use of EHRs;
• using demonstration projects to test new concepts in Medicare of "paying for performance" -- linking payments to quality of care rather than volume of services only.

"This plan sorts out the myriad of issues involved in achieving the benefits of health information technology, and it lays out a coherent direction for reaching our goals," Secretary Thompson said.

The report identifies three broad phases of implementation: developing the market institutions that are needed for a healthy market to exist in health information technology; encouraging investment both at the clinical level and in a new national network; and achieving high quality and performance accountability.

"This approach drives industry-wide change by focusing on the clinician and the consumer," Dr. Brailer said. "Our goal is to bring about improvement in health care from the inside out. This transformation will require the collaborative efforts and leadership of clinicians, consumers, hospitals, purchasers, payers, technology companies and informatic thought leaders to make this groundwork for change a reality."

New Action Announcements

Secretary Thompson announced a range of actions underway or soon to be launched, which will advance the strategic elements of the "Framework":

Appoint a Leadership Panel -- Secretary Thompson will appoint the panel of executives and leaders to assess the costs and benefits of health information technology to industry and society. The Health Information Technology Leadership Panel will deliver a report on these options to the Secretary no later than fall 2004.

Private sector certification of health information technology products -- Secretary Thompson said HHS is exploring ways to work with the private sector to develop product standards for EHR functionality, interoperability and security. A private sector ambulatory EHR certification task force is currently being formed. Product certification is especially important for smaller medical practices that need to be sure about what they're buying when they invest in EHR technology.

Funding community health information exchange demonstrations -- HHS' Health Resources and Services Administration, with the Foundation for eHealth Initiative, announced $2.3 million in contracts to support the Connecting Communities for Better Health Program. The program is providing seed funds to implement health information exchanges, including the formation of regional health information organizations.

Planning the formation of a private interoperability consortium -- To begin the process of movement toward a national health information network, Secretary Thompson announced that HHS will issue a Request For Information (RFI) this summer, inviting information about the requirements for private sector consortia that would form to plan, develop, and operate a health information network.

Requiring standards to facilitate electronic prescribing -- The Centers for Medicare & Medicaid Services (CMS) announced it is accelerating publication of a regulation laying out the first set of widely adopted e-prescribing standards in preparation for the implementation of the new Medicare drug benefit in 2006. The proposed regulation will be published by CMS this year.

Establishing a Medicare beneficiary portal -- CMS also announced it will develop a Medicare Beneficiary Portal, an immediate step in improving consumer access to personal and customized health information, providing secure health information via the Internet. The portal will enable authorized beneficiaries to have access to information about the health care services they have received under Medicare. The pilot test for the portal will be conducted in Indiana, beginning this year.

DOD, VA, OPM Reports Included

The President's April executive order also directed the Department of Veterans Affairs (VA), the Department of Defense (DOD), and the Office of Personnel Management (OPM) to report on how they will advance the adoption of health information technology. Their reports were also released today.

The VA, collaboratively with DoD, provide joint recommendations in their report on: lessons learned, the knowledge and technology transfers to be gained from successful VA/DoD data exchange initiatives, the adoption of common standards and terminologies to promote more effective and rapid development of health technologies, and the development of telehealth technologies to improve care in rural and remote areas.

The OPM report explores a variety of options to leverage its purchasing power and alliances to advance the adoption of health information technology.

Read HHS' Fact Sheet, "HIT Report At-A-Glance."

Read "The Decade of Health Information Technology: Delivering Consumer-Centric and Information-Rich Health Care" Framework for Strategic Action (PDF).

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