When a Native American military veteran who lives in Virginia goes to the doctor, it might be tricky to track down his medical records.
This hypothetical patient probably has received care from both the Veterans Affairs Department and the Indian Health Service. He has beneficiary data on file with the Social Security Administration, and also has a medical history with MedVirginia, a network of private health care providers.
To get this diverse group of entities to share data and en sure that the patient gets the best care is a difficult task, full of paperwork and phone calls.
The Obama administration is trying to change all that with the Nationwide Health Information Network (NHIN), an ambitious project that aims to get federal agencies to use common standards to record and store health records electronically. What's more, the administration is investing billions to encourage private providers to do the same.
NHIN "is able to take a process that manually might take several days and reduce that to several seconds," said Melissa Chapman, former chief information officer at the Health and Human Services Department and vice president of health solutions for the information technology firm Agilex Technologies.
Chapman left HHS in 2003, shortly after her office launched the Federal Health Architecture, the program office that is now working on software for the NHIN within HHS's Office of the National Coordinator of Health Information Technology (ONC).
Agilex is also helping develop the software.
The Bush administration created the ONC in 2004, but it had a budget of only about $60 million per year until the 2009 American Recovery and Reinvestment Act dramatically in creased its authority and funding. The office did important work from 2004 to 2009, Chapman said, laboring to establish common standards and specifications that have laid the groundwork for health information sharing via the NHIN.
Doug Fridsma, acting director of the ONC's office of inter operability and standards, compared the NHIN to the Internet — a set of services, standards and policies that allows for a free, secure flow of information between diverse sources.
With the stimulus bill, Congress and the administration moved to take electronic health record adoption and interoperability to the next level.
Dr. Robert Steinbrook reported last year in the New England Journal of Medicine that "there is no precedent for the act's massive investment in accelerating the adoption of health information technology — or for the expanded leadership role that government will assume in this arena."
In addition to increasing the ONC's budget to $2 billion, the stimulus bill also set aside $17.2 billion in financial incentives for physicians and hospitals to adopt electronic health records. Steinbrook's article stated that only about 17 percent of physicians and 8 to 10 percent of hospitals in the U.S. have even a basic electronic health record system. "Far fewer have — and routinely use — the types of comprehensive systems that would allow them to fully realize the potential of the technology," Steinbrook wrote.
The administration has vowed to ex tend electronic records to every American by 2014. Fridsma said that objective is ONC's top priority, but acknowledged that the goal will be challenging to reach.
"When 2014 comes, we anticipate there will likely still be work that needs to be done," Fridsma said.
Impact on federal agencies
Federal agencies are already reaping the benefits of electronic records and the NHIN.
The Social Security Administration was the first agency to join the NHIN in 2009, when it started sharing health information with MedVirginia to help process disability claims. Fridsma said the agency is expanding its use of NHIN, and information provided by SSA indicates that its information-sharing initiatives are working.
SSA is able to process medical records about 15 percent faster by electronically obtaining disability applicants' medical records and providing advice on disability claims to state and local officials, ac cording to agency CIO Frank Baitman.
"We're not processing these disability claims quickly enough," Baitman said at a federal IT leadership forum in June. "We believe the real game-changer is health IT.
We can sort through records from doctors and find the information that's relevant."
Fridsma said the Veterans Affairs and Defense departments are using the NHIN to exchange information on veterans and active-duty service members. The Centers for Medicare and Medicaid Services are providing financial support for CON NECT, the open-source software the government is using to develop the NHIN.
The Indian Health Service and the Centers for Disease Control and Prevention are also moving toward adoption of the NHIN, Fridsma said, and the ONC is in talks with other agencies.
"The agencies are contributing because they see this is a better solution than every body developing their own [system]," Fridsma said. "We think the more we can engage federal agencies, the better out comes we're going to have for patients."
Getting the private sector on board
Convincing private companies to invest in electronic health records and make the switch to the NHIN might be a tougher sell.
The health care industry faces a slew of new federal mandates and is trying to set priorities, said Dan Rode, vice president for policy and government relations at the American Health Information Management Association.
Health care providers have to up grade the software they use to en sure compliance with the Health Care Portability and Accountability Act (HIPAA), switch to a different classification system for diagnoses and procedures, and meet stricter privacy and security requirements under HIPAA, all by 2013, Rode said. Those rules are mandatory, while adopting electronic health records is voluntary — for now.
"For this industry that has taken so long to move, now we're moving very fast," Rode said. "It's not clear that everybody is under standing where we're headed, [but] we're headed in the right direction.
The question is: How do we keep everything shipshape and work through this perfect storm and come out on the other end with good quality data?" On July 13, the ONC and Centers for Medicare and Medicaid Services (CMS) released the final criteria for health care providers to become certified as "meaningful users" of health IT. Hospitals and physicians that prove they are using an electronic health record sys tem that meets the government's standards will be eligible starting next year for Medicare and Medic aid bonus payments of up to $11 million per hospital or $65,000 per doctor.
Carrots and sticks
In 2016, the government will switch from carrots to sticks: Providers that are not using electronic records would have their Medicare payments reduced.
The Congressional Budget Office predicted last year that the incentives and penalties would lead to electronic health record adoption rates of 70 percent for hospitals and 90 percent for physicians in 2019, as opposed to 45 percent and 65 percent under existing law.
CBO also reported that nationwide adoption would "reduce total spending on health care by diminishing the number of inappropriate tests and procedures, reducing paperwork and administrative over head, and decreasing the number of adverse events resulting from medical errors."
Chapman said patients would benefit from easier access to their historical medical information, even if it's generated by several different doctors in different special ties. Widespread adoption of electronic records would also create a massive body of data on medical treatment, helping pharmaceutical companies do research and development, and making it easier for the government to track usage of new drugs and conduct safety studies.
Chapman said electronic records would also pave the way for better tracking of fraud, waste and abuse in the Medicare and Medicaid pro grams, because CMS could quickly determine whether claims can be linked to an actual patient or treatment.
The overarching goal is a more efficient system of delivering health care in the public and private sectors, said Mary Jo Deering, a senior policy adviser at ONC.
"The ONC and this administration see technology not as an end in itself but as a means to an end, and that end is better health care," Deering said.