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05.09
IEEE-USA
Efforts to Advocate Use of Health Care IT
Substantially Mesh with Obama Administration
Initiatives
By Barton
Reppert
IEEE-USA’s efforts to advocate
greater use of modern information technology in
America’s health care system are in substantial
alignment with initiatives being mapped out by
the Obama Administration, which is aiming to
computerize the country’s health records within
five years.
“The current, paper-based
medical records system that relies on patients’
memory and reporting of their medical history is
prone to error, time-consuming, costly and
wasteful,” Peter B. Orszag, director of the
White House Office of Management and Budget,
said in testimony on 10 March before the Senate
Finance Committee.
Orszag noted that at present,
only about 17 percent of U.S. physicians and 8
to 11 percent of U.S. hospitals have at least a
basic electronic record system, while far fewer
have and routinely use the types of
comprehensive systems that would allow them to
fully realize the potential of the technology.
“With rigorous privacy standards
in place to protect sensitive medical records,
we are embarking on an effort to computerize
America’s health records in five years,” the OMB
chief said. “This effort will help prevent
medical errors and improve health care quality,
and is a necessary step in starting to modernize
the American health care system and reduce
unnecessary health care costs.”
The massive American Recovery
and Reinvestment Act draft legislative package
sent to Congress by the Administration includes
approximately $19.2 billion for health care
information technology (HIT). In addition to
adoption of electronic health records (EHR), the
technology initiatives include accelerated
development of a National Health Information
Network (NHIN).
Asked about the five-year target
on computerization of health records, Thomas C.
Jepsen, chair of the IEEE-USA Medical Technology
Policy Committee, responded: “We believe this is
ambitious but doable in the specified timeframe.
However, achieving this goal requires a clearly
articulated policy, buy-in by all the
stakeholders and an economic policy that
motivates health care providers to adopt online
medical records. Potential savings could be as
high as $200-300 billion per year.”
Congress is currently working on
bills (S. 350 in the Senate, H. 598 in the
House) which will spell out how the funding
allocated for health care information technology
will actually be used.
“In the past, there has been
broad bipartisan support in Congress for HIT,”
Jepsen told Today’s Engineer Online. “Given the
current economic situation, the primary issue
will be prioritizing HIT spending relative to
the other crises that we face in banking and
housing. However, I think there is general
agreement that we cannot afford to ignore the
problem, or to just kick it down the road.
Control of health care spending is essential to a
healthy economy in the U.S., and implementation
of HIT is an important element in constraining
the rising cost of health care.”
With regard to the National
Health Information Network, Jepsen said:
“President Obama’s plans for E-health are quite
compatible with IEEE-USA’s support for NHIN,
which was developed during the previous
Administration. While putting medical records
online benefits the individual health care
facility by eliminating the overhead of managing
paper-based records, the ability to share
records online among health care providers,
insurers and public health facilities provided
by NHIN greatly increases the efficiency of the
overall system of health care. The NHIN can be
seen as just one component needed to implement
the overall plan for E-health.”
In June 2005, the IEEE-USA Board
of Directors approved a position statement
declaring that “IEEE-USA advocates transitioning
from our current state of disconnected health
information systems to a National Health
Information Network (NHIN) that would make use
of leading-edge networking technologies, such as
web services, mobile communications and
multimedia communications to provide secure and
reliable transport of health care information.”
The position statement said that
transition to the NHIN “should be accomplished
by building upon existing systems by increasing
the reliability, availability and security of
these networks. . . . It should not rely upon
developing and maintaining new,
government-controlled, centralized databases or
personal health information repositories.”
According to a presentation by
Dr. Rainu Kaushal to a conference in September
2007 held at the National Institute of Standards
and Technology and co-sponsored by IEEE-USA,
implementation of the NHIN over a five-year
period would cost approximately $156 billion.
With regard to the issue of
enhancing patient safety, Jepsen — an IT
programming languages consultant based in Chapel
Hill, N.C. — observed that “implementation of EHR and NHIN as part of an overall E-health
strategy could significantly improve patient
safety. In 2000, the Institute of Medicine
estimated that 44,000 to 98,000 people die each
year from medical errors in hospitals. . . . The
fast and ubiquitous access to patient records
and other medical information provided by EHR
and NHIN could reduce the number of medical
errors due to inadequate information regarding a
patient’s history, prescribed medication and
current condition.”
Assessing the overall picture,
Jepsen observed that “IEEE-USA is deeply
concerned about the health of our health care
system and believes significant changes are
necessary. health care costs now account for 16
percent of the gross domestic product, and this
is expected to increase to 20 percent by 2016.
This rate of increase is not sustainable.”
In a 12 February 2007 letter
sent to selected members of Congress, then
IEEE-USA president John W. Meredith stated that
“we are approaching a crisis situation in
providing health care for our citizens that will
have consequences for the entire economy. Recent
studies have shown that health care costs
continue to rise while the quality of health
care
provided has fallen, and many millions remain
uninsured. Our nation’s manufacturers are losing
their competitive edge in the global
marketplace, due to the increasing burden of
covering employees’ health care costs. Solving
these problems will require prompt action by
both the public and private sectors.”
Meredith added that “IEEE-USA
believes that implementation of the online EHR,
the consumer-oriented PHR [personal health
record] and the NHIN will play a vital role in
providing a long-range solution to these
problems by reducing the number of medical
errors and increasing the cost-efficiency of
providing health care to all citizens.”
Another member of the Medical
Technology Policy Committee, Dr. Mark Ginsburg,
commented that the Administration’s goal of
computerizing America’s health records is
“extremely realistic in five years in the
broadband-enabled section of the country.”
However, he added that “if you don’t have a
network infrastructure, it’s almost impossible
to do what [OMB Director] Orszag wants in the
rural areas.”
Ginsburg, president of a
pediatric software company based in Tucson,
Ariz., said the U.S. medical profession has been
slow in adopting modern IT “because technology
vendors historically have not been using doctors
in designing systems, so the doctors are using
systems that are not intuitive, that are
unfriendly . . . So you have the standard
information system schism between designers and
users.”
He added: “We’re incredibly
backward in modeling the work situation and
designing software as to what they would expect
it to do and how it should work. In many cases
we’re using ancient user interfaces, very poor
business models. Many of the hospital systems
are really awkward and expensive. Many of the
early private practice efforts were extremely
unintuitive, with strange navigational keys. It
looks like 1980s mainframe computing. So what we
don’t have here is modern software engineering
informing the design process.”
Dr. Joel L. Nitzkin, also a
member of the Medical Technology Policy
Committee, has expressed strong skepticism about
the Obama Administration’s goal of achieving
computerization of America’s health records
within five years. “Computerize this nation's
health records in five years — some bits and
pieces yes; but the entire system — no way! It
just ain't going to happen, no matter how much
money they pump into the system,” he said.
Nitzkin told Today’s Engineer
Online that “according to the latest report
I have seen, we are now about 10-15 percent of
the way there. With maximum effort, I would
guess we might be between 30 percent and 50
percent in five years and maybe up to 80 percent
in 10 years. The rest — maybe never. There are
huge barriers having to do with cost,
organizational culture, issues of control,
privacy and security issues etc that are not
going to easily yield without bringing our
entire healthcare delivery system under a single
payer system — or something closely resembling
such a system.”
He added: “I may disagree with
some of my colleagues on the MTPC, but I think
that much of the NHIN network can proceed
without awaiting more widespread implementation
of electronic medical records. On an interim
basis we should be able to develop such a
national system based on data already
computerized by national drug store chains,
major insurance carriers and, within hospitals
and medical centers — lab and x-ray data. With
such a skeleton for the national system, EMRs
can then come on line as they are developed.”
Jepsen said there are many
opportunities for IEEE-USA members to become
involved in advocacy for health care legislation.
“One way is to participate in Congressional
Visits Day, in which members can present their
views directly to their representatives in
Congress. Another is to become a member of the
Medical Technology Policy Committee, in which we
create position statements and white papers, and
provide input to legislators on policy issues
relating to health care.”
He also noted that “there are
tremendous opportunities for engineers and IT
professionals in implementing E-health.
Professionals with the required skills in
information technology, telecommunications and
health care are in great demand, and there is
currently a shortage of people with these
skills. It has been estimated that as many as
212,000 new jobs will be created in this field.”
Barton Reppert is a freelance
science and technology writer specializing in
S&T policy coverage. He previously worked for 18
years as a reporter and editor with The
Associated Press in Washington, New York and
Moscow.
Comments on this article may be submitted to
todaysengineer@ieee.org.
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