Complementary WorkBy M.L. Baker
HHS Launches Health IT Collaborative
Health and Human Services Secretary Mike Leavitt announced Monday the formation of a "national collaboration" to create a technical standard by which disparate health information technologies would be able to communicate.
Leavitt will chair the 17-member American Health Information Community charged with accelerating a nationwide transition to networked electronic health records.
Health care costs now represent about 15 percent of the GDP, said Leavitt, that's three times the percentage in 1960.
While much of the increase is due to new technologies, economists estimate that about a third of the health care spent is wasted in services like redundant tests.
For health IT to decrease this waste, Leavitt said, the industry needs to share information so providers can better assess what services a patient needs.
Sharing information requires shared standards, and these standards should come from government-led "guided collaboration" rather than from government mandate or the "last vendor standing" in a competitive marketplace.
Scott Wallace, head of the National Alliance for Health Information Technology (the Alliance), a consortium of health care payers, providers and technology vendors, said the move was "an unprecedented level of engagement by a Cabinet secretary in fundamental technology," and that his involvement might hasten the development of standards by taking them out of a business and policy vacuum.
"The private sector tends to be pretty slow" at developing standards, said Wallace. "Debates are not occurring between the clinicians and businesses who will use them but the technologists that develop them, and that's not good."
At a speech in February, David Brailer, the National Health IT Coordinator, hinted that if the industry failed to adopt common standards, the government would be forced to step in.
But Rob Seliger, CEO of Sentillion and chair of the interoperability working group at HIMSS (Health Information Management and Systems Society), welcomed Leavitt's involvement despite a risk of excessive government involvement.
"I think he goes into it not with the intent of a heavy hand but with being a catalyst. The fact that he's going to chair it is a monumental step for this industry."
The AHIC will help "line up all the rails," said Leavitt, a reference to problems in the U.S. railway system in the 19th century, when regions laid down tracks of varying width that could not be shared across the nation.
The AHIC will include members throughout the health care industry, as well as local and state governments. HHS will solicit nominations for members of the committee.
Leavitt said that the AHIC would provide deliverables within months, and hinted that these would include a process for setting standards for interoperability and certifying compliance.
The Certification Commission for Healthcare Information Technology, an industry collaborative that formed last year by the Alliance, announced Monday that "the goal of creating a credible, voluntary process for certifying electronic health record [EHR] products is in sight," and that a certification program would be in place by the end of the year.
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Wallace said AHIC's work and the Commission's work were complementary. AHIC will define what standards are needed, and the Certification Committee takes standards and applies them very specifically to products.
Part of the AHIC's role will be to take the best of many regional efforts in health IT.
"We're not going to reinvent anything; we'll build on the standardization that already exists," said Leavitt, "giving shape to the mass of things that are already happening."
AHIC will dissolve after five years. After that time, a private-sector health information community initiative should step into AHIC's role to set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation.
On Tuesday, HHS is expected to give details on four funding opportunities related to AHIC's goals.
Seliger said people are still waiting to know when the money will flow. But when it does, he said, seed projects will fall on fertile ground.
Fifteen to 20 years ago, efforts to establish community health information networks failed, he said, but current efforts are more likely to succeed because of access to money and the Internet, and because of "an expectation that didn't exist 20 years ago."
At that time, he said, many health care providers feared that "by collaborating, they would undermine their competivity in the marketplace. Those fears have not only subsided, I think they are early nonexistent."
However, Leavitt said that the AHIC would address only one of what he views as health IT's three major problems. The other two are focusing on treatment rather than wellness, and misaligned incentives for health care providers, payers, and patients.
Nor will the AHIC deal with the "adoption gap" being created as health IT is increasingly adopted in large health care organizations, but not in offices with only a few physicians, which provide most health care.
Another part of the government's role is providing seed money, said Leavitt. In total, HHS will spend $86.5 million on health IT this year, and President Bush has requested $125 million for health IT for next year.
Leavitt said solving these issues is constantly on his mind.
"Every morning I get up and think of three things: health IT, health IT, health IT."
In a press release accompanying Leavitt's speech, HHS laid out AHIC's tasks:
1. Make recommendations on how to protect privacy and security.
2. Identify and make recommendations for prioritizing health information technology achievements that will provide immediate benefits to consumers of health care (e.g., drug safety, lab results, bio-terrorism surveillance).
3. Make recommendations regarding the creation of a private-sector, consensus-based, standard-setting and harmonization process, and a separate product certification process.
4. Make recommendations for a nationwide architecture that uses the Internet to share health information in a secure and timely manner.
5. Make recommendations on how the AHIC can be succeeded by a private-sector health information community initiative within five years. The sunset of the AHIC, after no more than five years, will be written into the charter.
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