For a president whose campaign was buoyed by use of Web 2.0 technologies like YouTube, Twitter, FaceBook and blogging, it should come as no surprise that President Barack Obama has made upgrading the nation’s old-fashioned healthcare IT infrastructure a priority. Even without the tech-savvy staff now occupying 1600 Pennsylvania Ave., the current economic crisis has thrown the need to find more efficient ways to manage healthcare into sharp relief. According to the National Coalition on Health Care, healthcare spending in the United States reached $2.4 trillion in 2008 and is projected to reach $3.1 trillion in 2012. Finding ways to control costs associated with healthcare delivery will be critical to Obama’s efforts to stem the tide of the current global recession.
Within a month of taking office, Obama signed the American Recovery and Reinvestment Act of 2009, which includes $19.2 billion in funding for healthcare information technology (HIT). Among its provisions, collectively referred to as HITECH, are establishment of the Office of the National Coordinator for Health Information Technology (ONCHIT) within the Health and Human Services Department (HHS), to promote the development of a nationwide interoperable HIT infrastructure; financial incentives through the Medicare program to encourage physicians and hospitals to adopt and use certified electronic health records (EHR) and penalties beginning in 2019 for those who do not; and the expansion of the Health Insurance Portability and Accountability Act (HIPAA) to protect patient health information and apply it not just to covered entities but also to their business associates.
The sheer amount of funding going into HIT from the federal government means that the next decade will be full of opportunities for vendors that are providing effective solutions for managing, connecting and securing the vast amounts of data that are held within the national healthcare system. H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society (HIMSS), the country’s largest healthcare association focused on information technology, says, "The federal government has never paid for the management of data before. It’s a total game changer."
If ever there were a compelling argument for the value of presenting content in context, you’d make it when robed in a paper gown, watching your physician look up information on a mobile device to pin down diagnosis and treatment options. Existing KM vendors and new market entrants alike are eyeing the ways in which innovative application of content and knowledge management solutions can improve healthcare delivery outcomes and lower costs.
Incentive for growth, but obstacles remain
One of most obvious areas for improvements in data and content management is in the arena of electronic patient records. Broadly speaking, those records are broken down into two categories: electronic health records (EHRs) used by healthcare providers to document and manage patient care, and personal health records (PHRs,), which target healthcare consumers and put them in control of their own medical data.
EHRs are generally used by clinics and hospitals to record patient and demographic data, view and manage lab results, record prescriptions and support clinical decisions. As a measure of the limited penetration of the EHR market to date, a 2008 study published in The New England Journal of Medicine found that only 17 percent of 2,758 physicians surveyed had fully functional EHRs, mainly those with larger practices and/or younger physicians. Yet more than 50 percent of those with EHRs in place said that information from their systems had helped them prevent dangerous drug interactions, spot a drug allergy, order critical lab tests or identify a critical lab value.
The good news is that the same survey found strong indications of increased adoption. Sixteen percent of doctors without EHRs were in the process of implementing systems, and another 26 percent intend to do so within the next two years. HITECH provides powerful incentives. With the average cost of implementing an EHR estimated at $40,000, physicians making "meaningful use" of a "certified" EHR by 2012 stand to receive up to $44,000 in ARRA funds.
What’s meaningful use? What’s certified? That is still hard to say, but it’s getting ironed out. Lieber points out that HITECH legislation dictates that those definitions must be finalized by ONCHIT by no later than Dec. 31 of this year.
"We expect the initial rules to be reasonable but challenging," Lieber says. "They’ll set a baseline from which expectations will be ratcheted up." Also in development are the specific rules and systems for reimbursing physicians for EHR implementation, but Lieber expects those funds to start flowing no later than 2011.
Issues of data interoperability and cost also need to be addressed if goals for HIT adoption are to be met. Carlton Dody, research director at Forrester Research, says, "The pessimist in me says that we’ve seen this attempt before. As a colleague of mine puts it, ‘Electronic medical records have been five years away for the past 25 years.’" But Dody also believes that use of cloud computing infrastructure is helping to drive down implementation costs to a level where even smaller practices can afford EHRs.
Ramping up involvement
Even so, established EHR providers like GE Healthcare, McKesson and Cerner are placing their bets. In May, GE announced its "healthymagination" initiative, committing $6 billion over six years to a range of initiatives including accelerating healthcare information technology. A month earlier, the "EHR Stimulus Alliance," comprising Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft, and Nuance Communications, hit the road to educate doctors about available tools for setting up EHRs.
The scope of the market is pulling non-traditional players into the electronic records game. In March 2009, Wal-Mart announced that it would be targeting the SMB market through a joint effort by its Sam’s Club division, eClinicalWorks and Dell. The eClinicalWorks software will be delivered through a software-as-a-service (SaaS) model. With an estimated 200,000 medical providers among the 47 million Sam’s Club members nationwide, Wal-Mart is betting that accessibility and affordability will provide a competitive advantage.
Decision support tools are a critical component of certified EHRs. Lieber says, "EHR vendors are focused on including them, either through partnerships or building them themselves." Natural language processing is a popular approach. In April 2009, the Mayo Clinic and IBM announced an open source initiative called the Open Health Natural Language Processing (NLP) Consortium, aimed at supporting development of biomedical natural language processing systems.
But NLP isn’t the end of the story. "There are still untapped places for traditional analytics technology to grab hold of this industry," Dody observes.
Health records get personal
Another area poised for a boost is in consumer-controlled health data. Personal health records are tools for enabling consumers to play a more active role in their healthcare. Theoretically, an accurate and comprehensive PHR helps consumers check for errors in medical records, track spending, avoid duplicate tests and keep their physicians informed of their health status. But as a 2008 survey funded by the Markle Foundation found, only 2.7 percent of nearly 1,600 respondents surveyed had a PHR, and privacy concerns are a major reason. Nearly nine in 10 respondents said privacy practices are a factor in their decision not to use a PHR.