Standing on the steps of the Lincoln Memorial on Nov.
9, 2008, I observed newly erected plywood walls with posters of
signatures and e-mail printouts not only congratulating President-elect
Obama but also giving voice to the many wishes and dreams of the people.
One section of the walls read: “Change Won’t Be Easy, but Together as
One World, Yes, We Can.” And healthcare was mentioned several times on
the temporary monument in the Mall.
We are now at the five-year mark since President
Bush’s 2004 Executive Order that U.S. citizens should have access to
electronic health records by 2014. That was a tall order to fill with
the meager tools available at the time, but since then a remarkable list
of accomplishments have been achieved.
Federal HIT strategic plan and states’ initiatives
One of these, released in June 2008, the Federal
Health Information Technology Strategic Plan (available online at
www.hhs.gov/healthit ), addresses two main goals: patient-focused
healthcare and population health. A matrix of eight objectives against
these two goals intersects along four themes: privacy and security,
interoperability, adoption, and collaborative governance. Each of the
eight objectives has a measurement and a milestone.
The federal efforts (CDC, FDA, NIH, DOD, CMS, NASA,
DOE, VA, and others) are joined by states’ initiatives. Governors have
formed Centers for Excellence, and some have provided budgets for
healthcare information technology (HIT) development. Collaborations
among 42 states and territories have studied local and intrastate
security and privacy legislations which might have stymied each state’s
ability to share patient-elected information across boundaries.
HIE, AHIC, and NHIN progress
Another accomplishment: Federal grants were awarded
to selected states to implement, test, and demonstrate core capabilities
of health information exchange (HIE).
And, most recently, at the November 14 American
Health Information Community meeting, members had completed
specifications and testing of seven priority-use cases.
Demonstrations of progress were held December 2008 at
the National Health Information Network Forum in Washington, DC. (All
information is available to the public at
www.hhs.gov/healthit/community/meetings , including archived
webcasts.)
Obama’s economic-recovery plan
Meanwhile, President-elect Obama’s economic-recovery
package is centered on education, energy and the environment, and
poverty and health. In his Dec. 6 radio address, Obama announced that
HIT will be included in the plan, with HIT and HIE identified as
essential infrastructure tools. An infusion of funds into HIT and HIE
creates more jobs and further improves patient outcomes, among other
benefits.
That same month, the Congressional Budget Office
(CBO) advised that the requirement of using HIT to participate in
Medicare could save the government $7 billion over five years and $34
billion over 10 years. Savings would be achieved primarily through
reduction in medical errors and unnecessary test procedures. The CBO
also stated that the requirement would lower private-sector
health-insurance premiums.
With such cost and benefit estimates, President-elect
Obama’s recent recovery-plan draft calls for $10 billion per year for
the next five years. Both the House and Senate pushed to get the
economic-recovery bill ready for Obama’s signature by Inauguration Day.
Health policy transition underway
The Obama Health Policy Transition Team, headed by
(at the time of this writing) Secretary-designate of Health and
Human Services (HHS) Tom Daschle, has been aligning grassroots community
discussions with the early drafts of the American Recovery and
Reinvestment Plan. Civic engagement is encouraged at www.change.gov;
many industry leaders and communities have provided input.
On Jan. 15, 2009, IBM CEO Samuel Palmisano, for
example, advised that $30 billion spent on digitizing health records,
bolstering broadband access, and further expanding the electrical grid
could create more than 900,000 jobs.
Washington’s Information Technology and Innovation
Foundation think tank advised the Transition Team that $10 billion in
HIT could create 212,000 jobs.
Laboratory personnel called to serve
Investment in HIT and HIE means that laboratorians
will be called to serve as subject-matter experts to bridge their lab
systems. Tasks may include translation assistance to international
vocabulary standards, such as LOINC or SNOMED CT.
To prepare, refer to the National Library of
Medicine/National Institute of Health website,
www.nlm.nih.gov,
and HHS’ website, www.hhs.gov/healthit.
Pamela Banning, MT(ASCP), CLS(NCA), PMP(PMI), serves
on the Logical Observation Identifiers Names and Codes (LOINC)
Committee, developing standardized terminology for all facets of
medical-laboratory reporting. She is a healthcare data analyst for 3M
HIS Terminology Consulting Services. Reach her at
[email protected].
