National Health Information Network: Who Will Be Left Behind?
As Bush administration calls for national computerized health records, Harvard, BWH researchers outline what it will take to get there in five years
Boston - President George W. Bush has stated that electronic health records should be uniformly adopted by 2014. In an effort to help advise Congressional and Senate legislation regarding health information technology, a team of researchers from Harvard and Brigham and Women's Hospital (BWH) recently reported that a national health information network (NHIN) may cost approximately $156 billion. Now, the same team of researchers has published a report that outlines the critical features of a realistic NHIN model that can be achieved in five years. Importantly, they also identify the key stakeholders who have the largest gaps to overcome.
The study appears in the September 14, 2005 issue of the journal, Health Affairs.
According to lead author Rainu Kaushal, MD, MPH, a patient safety researcher at BWH, "Various stakeholders in health care are estimated to spend $24 billion over the next five years on information technology, but before hospitals, pharmacies, physicians’ offices, and other key players begin moving in different directions, our research team wanted to help create definition around what a model NHIN should look like. With the input of an expert panel we determined the health information technologies that are critical requirements of a national network and defined the gaps between what exits today and what will be needed to meet the standards of a model NHIN."
The team defined the key stakeholders as: physicians’ offices, hospitals, skilled nursing facilities, home health agencies, clinical laboratories and pharmacies. They prioritized the following functional capabilities as the most important technology features of a model NHIN:
· Electronic result viewing of ordered tests
· Electronic health records (EHR)
· Computerized physician order entry (CPOE)
· Electronic claims submission
· Electronic eligibility verification
· Secure electronic patient communication
· Electronic prescription acceptance by pharmacies
The report suggests that administrative functionalities will continue to be adopted more quickly than clinical ones because they offer direct financial incentives. In terms of clinical functionalities, results viewing is projected to be most prevalent since it requires the least amount of technical sophistication, is easily integrated into existing workflow, and provides direct benefits to users. Additionally, the panel indicated that skilled nursing facilities and home health agencies, the stakeholders with the greatest financial and personnel constraints, will experience the slowest conversion to technology. For example, only 14 percent of skilled nursing facilities are expected to have EHRs and CPOE in five years compared to approximately 50 percent of large hospitals.
"Our assessment demonstrates that when it comes time to fit into the mold of a NHIN, large hospitals may be in the best shape because they have already begun to make many technology investments, while smaller stakeholders such as skilled nursing facilities are most likely to be left behind," said Kaushal, also an assistant professor of Public Health and Medicine at New York Presbyterian HealthCare System/Weill Medical College. "The findings therefore suggest policy interventions and financial incentives should preferentially target stakeholders with limited technology resources to prevent safety gaps from growing and patients from facing inequities as they move through the healthcare system. As witnessed with the implementation of policies like HIPAA, the government can be an important catalyst for conversion to electronic systems."
The research was funded by the Commonwealth Fund and the Harvard Interfaculty Program for Health Systems Improvement.
Please contact BWH Media Relations for more information at (617) 534-1600 or BWHMediaRelations@partners.org.
BWH is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832 and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives, dedication to educating and training health care professionals, and strength in biomedical research. With $370M in funding and more than 500 research scientists, BWH is an acclaimed leader in clinical, basic and epidemiological investigation - including the landmark Nurses Health Study, Physicians Health Studies, and the Women's Health Initiative. For more information visit www.brighamandwomens.org
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