A Letter to Pres.-Elect Obama on HIE and the New Political Landscape by Christina Beach Thielst, FACHE

Dear President-elect Barack Obama:

On the journey toward widespread implementation of health IT and electronic exchange we once again find ourselves at a crossroads.  Our destination (vision) is to bring an individual’s health information to the point of care whenever and wherever it is needed.  As healthcare professionals, we look forward to working with you to reinvigorate our efforts and implement needed change, so we may continue down the right path toward our ultimate goals to improve the efficiency, effectiveness, access, safety and quality of healthcare.

Healthcare is:

·         one of the most regulated industries,

·         one of the highest costs for our nation, and ironically,

·         one of the last to implement electronic information technologies.

The reasons for the delays in implementation are due to the complexities of sharing detailed and private data on every person receiving healthcare the country and the disconnect between those who bear the cost and those who receive the greatest return on another’s investment.  Thin margins don’t leave much room for many providers (hospitals, doctors and others) to have the funds for anything but modest steps forward implementing one system at a time.  And, while providers do realize reductions in costs due to increased efficiency,  payors (Medicaid, Medicare, private insurance, employers, etc) and others receive more significant returns with little, if any, investment.

While some health plan leaders are taking steps to more rapidly advance the implementation of HIT, payor reliance on actuarial data collected over several years is contributing to only modest steps forward.  Interestingly, those payors who are also providers of healthcare, such as, the Veterans Administration and Kaiser, tend to recognize the benefits sooner and are often more advanced in their application of health  IT within their system.

The opportunities for cost savings increase dramatically when the interoperable exchange of health information between organizations and systems enters the discussion.  And here, many stakeholders including payors, are joining with providers in distinct communities to work towards electronic HIE.   Much has been accomplished in these local, regional or state-wide community collaboratives, which are sometimes guided by more formal RHIOs.  However, much more is needed to reach deep into every community, region or state for widespread HIE.

The eHealth Initiative’s 2008 Annual Survey on Health Information Exchange Initiative[i] summarizes the difficulties:

·         half of the 130 participants surveyed report that development of a sustainable business model is very difficult, and

·         47 % say securing upfront funding is very difficult. 

Healthcare at the Crossroads:  Guiding Principles for the Development of the Hospital of the Future[ii], a Joint Commission report emphasizing the importance of health IT to hospital viability, presents recommendations to enhance healthcare quality and safety and support the migration of hospital-based care into the community and home settings. 

·         adopt labor-saving and integrative technologies across the hospital

·         identify reliable individuals to provide technology assessment and investment guidance for hospitals

·         make the business case and sustaining funding to support the widespread adoption of health IT, and

·         redesign business and care processes in tandem with health IT adoption.

And, just as more and more communities are looking toward implementation of needed technologies, the tightening economy is causing more and more companies with limited or no connection to the industry to see healthcare as a lucrative and relatively untapped market, thereby heightening the importance of reliable individuals to provide guidance.

In summary, I ask that you continue your support for health IT and HIE implementation and help collaborating communities by removing obstacles impeding their progress toward providing the right care for the right patient at the right time.

Christina Beach Thielst, FACHE, is the Chief Operating Officer of Santa Paula Hospital, a campus of Ventura County Medical Center, in Santa Paula, CA.   She is also editor of HIMSS Guide for Establishing Regional Health Information Organizations.