Trend Tracker | Report from the NHII Secretarial Summit on Health IT

"We're from Washington, and we're here to help."

The Secretarial Summit on Health Information Technology was the scene in late July for the latest gathering of government and industry, launching the National Healthcare Information Infrastructure (NHII) 2004: Cornerstones for Electronic Healthcare meeting at the Washington, D.C. Convention Center. Not surprisingly, a standing-room-only audience estimated at 2,000-plus paid close attention in the search for the holy grail of current healthcare IT discussions - the EHR market. Frankly, it was an interesting collection of high-level government and hospital types mingling with salesmen, better described as healthcare IT vendor executives.

For sure, Washington politicians are sincerely trying to help, and they lined up commitments and presentations from every healthcare related agency in the Federal government - now that's a major undertaking, when you consider the scope of government programs lately.

And these agencies and politicians are all focused on the common agenda - getting re-elected while working on the controlling the cost of healthcare and the un-advertised medical errors rate in the U.S. From my perspective, medical errors is beginning to look like a disease, with health IT as the prescribed cure.

As with any serious effort, commitment starts at the top, and in this case, the meeting started and ended with talks from the HHS Secretary Tommy Thompson.

David Brailer, MD, the national coordinator for health information technology, was almost solely responsible for this meeting's content. Senate Majority Leader Bill Frist, MD, weighed in on the legislative front, while former Speaker of the House Newt Gingrich provided some perspective on the challenges and rewards of effecting the institutional change and progress that the EHR offers. So what really happened here?

First, a new report was released. After all, this is Washington. "Framework for Strategic Action: The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care" outlines the Bush administration's stated vision for the majority of Americans to have interoperable electronic health records within 10 years. This report outlines 12 strategies to achieve four goals related to the vision. These four goals include:

  • Introduction of information tools into clinical practice
  • Electronically connecting clinicians to other clinicians
  • Using information tools to personalize care delivery
  • Advancing surveillance and reporting for population health improvement

Somehow, no one had any concern and little discussion regarding the vision, the goals or the strategies that may lead us to this futureworld of electronic health records. I fully expect to see a new ride at Epcot next spring devoted to EHRs. However, when you ask a physician in private practice or a hospital that is under budget pressures (that's pretty much the entire market) to open its wallet, the discussion really gets pointed and specific. At this stage of the game, there are few examples of successful and productive EHR's in operation. OK, we've now all learned, thanks to this meeting, that the VA and Department of Defense have robust and active health IT projects, built on EHRs that work. But the VA and DoD are not exactly well-accepted models for most hospital and group practices to base their EHR spending on, as these systems are pretty much one-of-a-kind, not off-the-shelf. But, upon further reflection, the DIN-PACS project undertaken by the VA more than 10 years ago has many similarities to today's EHR projects, and now look where the PACS market is - a commodity that you can find everywhere.

So whether you think the EHR will happen in 5, 10 or 20 years, it's coming. The current intense focus on standards, for many aspects required to make health IT interoperable, represents the necessary technical aspect that ultimately makes these systems functional and affordable.

While Dr. Brailer and others believe that regional exchanges represent a scalable model for deploying a national health IT infrastructure, I'm not sure that hospitals have warmed up to this idea yet. Will Washington fund these? Now that's something that makes a politician's heart beat faster - just don't put it in their EHR without their permission!

Seriously, Dr. Brailer is taking on a job to educate all of us regarding the realities of EHRs. There will be no magic act here, just plenty of technical work, failures and successes we can learn from. I think that interoperable systems and EHR's will ultimately deliver more change to our healthcare system than even the wildest guess currently imagines, as health IT systems remake the balance of power and control of healthcare institutions in favor of individuals.

Making money in this market probably represents a bigger challenge right now than the technical aspects of deploying health IT systems. And while official Washington can prime the pump with demonstrations and projects, the real market will start when small hospitals and private physicians jump in. HIPAA looks easy compared to health IT

Douglas F. Orr is Principal of J&M Group. Send Trend Tracker questions and comments to