RSNA News - October 2004

HHS Launches "Decade of Health Information Technology"

RSNA can be very proud that the IHE initiative is at the leading edge in the development of the electronic health record.
— David S. Channin, M.D.

Tommy Thompson

Health and Human Services Secretary

Health and Human Services (HHS) Secretary Tommy Thompson did everything but wear a train conductor's hat and toot a whistle when he unveiled the first outline of a 10-year plan to transform the delivery of healthcare by building a new health information infrastructure.

At a secretarial summit on health information technology on July 21 in Washington, D.C., Thompson excitedly announced, "The train is leaving the station!"

Thompson's exhilaration seemed to stem from the fact that people are finally listening to him. He noted that he has been talking about digital healthcare records for the past three years—and few have seemed to listen. But on that morning, more than 1,400 people attended the summit.

"America needs to move much faster to adopt information technology in the healthcare system," he said. "Electronic health information will provide a quantum leap in patient power, doctor power and effective healthcare."

With Thompson at the podium was Robert Goldszer, M.D., M.B.A., associate chief medical officer and director of primary care in the Department of Medicine at Brigham and Women's Hospital (BWH) in Boston. Dr. Goldszer had actually hopped aboard the train a decade ago. He says the 10 primary care sites in his network have already established electronic medical records for every patient.

Dr. Goldszer says that in his network, physicians can order an imaging study through the radiology site on the home portal page. The physician's and patient's contact information and other data are automatically entered as part of the request, he says, adding that improved accuracy saves money, as does the radiology department's printing of imaging studies on CD as opposed to film. The availability of digitized imaging studies online, with the exception of mammography, also allows primary care physicians to view those studies whenever and wherever they want.

BWH is apparently the exception. The overwhelming majority of hospitals and physician practices have been slow to accept computerization. Hospital use of electronic health records (EHRs) in 2002 was reported at 13 percent, according to an HHS fact sheet. Adoption by physicians' practices varied from 14 percent to a possible high of 28 percent, depending on the size of the practice.

David J. Brailer, M.D., Ph.D.

National Coordinator for Health Information Technology

Just as adoption of EHRs has been slow, so will efforts to translate the strategic vision presented at the summit. David J. Brailer, M.D., Ph.D., the new national coordinator for Health Information Technology (HIT) candidly admitted as much.

Dr. Brailer prepared the report, "The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care," that was released at the summit. The report says federal leadership can help hasten efforts to be carried out by the private sector. The report identifies four major goals with strategic action areas for each:

• Goal 1 - Inform Clinical Practice: Bringing information tools to the point of care, especially by investing in EHR systems in physician offices and hospitals.
• Goal 2 - Interconnect Clinicians: Building an interoperable health information infrastructure, so that records follow the patient and clinicians have access to critical healthcare information when treatment decisions are being made.
• Goal 3 - Personalize Care: Using health information technology to give consumers more access and involvement in health decisions.
• Goal 4 - Improve Population Health: Expanding capacity for public health monitoring, quality of care measurement, and bringing research advances more quickly into medical practice.

The framework lists a number of actions HHS will begin over the next year to accelerate medicine's embrace of electronic records, but Dr. Brailer emphasized: "This is a framework. It is not a full-blown strategic plan. It is intended to stimulate dialogue."

Cost of the Initiative

While cost didn't come up during the summit, cost implications were discussed after the summit. "Dr. Brailer's plan relies on strategies that the American College of Physicians (ACP) has previously identified as crucial for success, such as providing incentives for the adoption of HIT and promulgating interoperable standards," says John Tooker, M.D., M.B.A., chief executive officer of ACP. "Approximately half of the practicing physicians in the United States work in practices with six or fewer physicians. The average cost for an EHR system is $30,000 per physician. This initial cost, combined with the expense for transferring patient records and maintaining the system, often puts these systems out of the reach of small physician practices."

Thompson has said he would appoint an HIT Leadership Panel, composed mostly of industry executives, who will report to him by the end of this fall on specific options for reaching general objectives of the strategic framework.

Thompson also says HHS is exploring ways to work with the private sector to develop product standards for EHR functionality, interoperability and security.

Integrating the Healthcare Enterprise Initiative

Showcase Exhibit at RSNA 2004 The infoRAD showcase exhibit at RSNA 2004 will highlight IHE stories from users who have successfully implemented various aspects of IHE. There will also be a hands-on exhibit showing an advanced filmless environment based on IHE capabilities. For more information on infoRAD at RSNA 2004, see "Technical Exhibits and infoRAD Exhibits".

Six years ago, RSNA and the Healthcare Information and Management Systems Society (HIMSS) launched the Integrating the Healthcare Enterprise (IHE) initiative. Under IHE, RSNA and HIMSS are helping technology professionals and healthcare industry leaders improve the way computer systems in healthcare share critical information. This involves establishing a common language so that images and patient data can be easily and efficiently communicated across the healthcare enterprise.

"IHE was a cornerstone of several proposals that came out of the breakout sessions at the summit," says David S. Channin, M.D., a member of the RSNA Electronic Communications Committee. "RSNA can be very proud that the IHE initiative is at the leading edge in the development of EHR."

HIMSS President H. Stephen Lieber, C.A.E., was also at the summit. "HIMSS will work closely with Dr. Brailer and his office to enhance their understanding of IHE and to demonstrate how IHE meets their present and future interoperability goals," he says, adding that RSNA and HIMSS will also seek federal endorsement and support of the IHE initiative.

"With many organizations now vying for the available federal dollars for this new plan, RSNA and HIMSS will continue to work with Dr. Brailer to move his agenda forward," Lieber says. "The key will be for the government to provide adequate support to drive industry toward accomplishment of Dr. Brailer's agenda."

Dr. Channin adds, "The very successful IHE process is being recognized as one way to organize the monstrous task of developing an electronic health record. IHE has solved some very complex technical problems as to how to get heterogeneous information systems to interoperate to get the job done. Although IHE has its roots in radiology, it is now addressing needs in intra- and inter-institutional situations. RSNA and HIMSS, as co-developers of IHE, must now lead the way in developing standardized content for the radiology components of the EHR."

Since IHE was established in 1998, it has expanded from radiology and IT infrastructure to cardiology and clinical laboratory and pathology. The American College of Cardiology recently agreed to sponsor the IHE work in cardiology. IHE has also grown internationally with activities under way in Asia, Europe and North America.