Use of the EHR is absolutely inevitable, said Daivd Brailer, PhD, MD, national coordinator for health information technology. His talk at last year's AHIMA meeting was a time to talk about possibilities and explore directions for the road to EHR implementation. "Last year was the beginning of the beginning. Here I am again, a year later, and we are at the end of the beginning," he said. "The time for action has begun." Healthcare professionals now have a better understanding of what is at stake regarding HIT, such as reducing medical errors and the costs of healthcare fraud, he said. Consumer demands have increased for information and access.

Brailer cited this year's hurricanes and their aftermath as demonstrating that portable health information has the potential to save lives. "Information is therapy, and the use of these tools can have the same kind of clinical benefits as a pill or a procedure." However, "a physician using a computer is not e-health. The key to interoperability is a doctor using an application that is designed correctly and connected to other applications so that information is portable." That "is a game-changing event."

Contracts granted in recent months are working toward Brailer's goals. HHS has awarded a contract to perform an annual survey on IT adoption. And the OIG and CMS recently proposed safe harbors that would allow hospitals to donate certified EHR technology to physicians without risking problems with the anti-kickback or Stark laws.

Challenges remain, such as designing electronic record systems that are easy to use. Lower costs are needed so that the systems will be available to all providers. And, the industry needs knowledgeable professionals to implement the new systems.
   
Brailer said he expects the next year to be even more eventful.
   
Meanwhile, those events Brailer mentioned are already underway with a report to Congress and a new standards repository.
   
Just this week, the Commission on Systemic Interoperability (CSI) released its report "Ending the Document Game" to Congress. Directed to the American public, the report suggests that there are three steps necessary to create a connected nationwide system of health information-adoption, interoperability, and connectivity-and notes that "interoperability focuses on the need for healthcare information to be connected so information is accessible whenever and wherever it is needed and authorized."

To advance the adoption of HIT the CSI suggests five steps:

1. adopt and implement, financial and other incentives
2. revise or eliminate regulations that prevent entities from working together for interoperability
3. an annual report from HHS that would report on the adoption gaps
4. identification of and planning for addressing work force needs
5. development of a public awareness campaign

To advance interoperability the commission suggests:

1. product certification for information technology products
2. use of interoperable, non-overlapping data standards
3. standardization of identifiers and vocabulary for drug and laboratory products
4. establishment of a robust interoperable drug record for every American by 2010

Finally, to advance progress of connectivity of HIT, the CSI suggests:

1. development of a national standard for determining patient authentication and identity
2. a uniform federal health information privacy standard
3. development of a nationwide health information network to ensure the safety and security of the American public as part of the national security infrastructure
4. criminal sanctions for privacy violations by individuals who intentionally access PHI without authorization
5. consumer protection from the consequences of unauthorized access or release of PHI

You can access the full report at http://endingthedocumentgame.gov/.

The National Institute of Standards and Technology (NIST) is working with standards development groups to develop a Web-based repository of information called the Health Care Standards Landscape (HCSL). The repository will provide a comprehensive source of information on healthcare standards, standards development organizations, and organizations that implement healthcare standards.

NIST notes that "HCSL currently is a prototype which includes both real and sample data to demonstrate its capabilities." NIST is inviting healthcare standards developers, users, and others to evaluate HCSL and provide comments by visiting http://www.itl.nist.gov/div897/docs/hc_roadmap.html. Go to http://www.nist.gov/public_affairs/techbeat/tb2005_1020.htm#it to see the NIST notice.