Where will health IT be in 2015? If we achieve all of the goals of the updated Office of the National Coordinator strategic plan, it will be in an ideal state.
Everybody will have electronic health records (EHRs); all information systems will all be interoperable; EHR us ers will all achieve meaningful use (stages 2 and 3 included); there will be no more security breaches; patients will be using electronic copies of their records to manage their own health; and health IT will help healthcare reform attain its goals, including effective population health management, superb care coordination, lower costs, and optimal patient outcomes.
Of course, this is only an aspiration; nobody really believes that this vision will be achieved within five years, just as
nobody believes that EHRs will be universal by 2014, as President Obama and, before him, President Bush demanded. Bush's time frame was 10 years -- roughly the same amount of time it took us to land a man on the moon. The reason why it won't happen within that time frame is that widespread health IT adoption and the ultimate goals of meaningful use are much harder to achieve than winning the "space race" was in the 1960s.
The lunar landing required the development of new technologies and a major national investment in the manned space project. It was backed by the military, which used public fear of the Soviet Union to build support for the space race. And in the end, all we had to do was put one man on the moon to win the contest.
The ultimate aim of the HITECH Act and meaningful use is to change fundamental aspects of the health care industry -- a business that represents a sixth of our GDP, or about $2.5 trillion a year and growing. This is not just about getting doctors and nurses to document their work electronically, nor is it about exchanging healthcare information online. Both of those goals are steps toward a reordering of the entire healthcare enterprise. Goal #2 in the strategic plan sums it up nicely: "improve care, improve population health, and reduce health costs through the use of health IT."
There is no doubt that the HITECH Act and the expeditious, far-sighted work of David Blumenthal and the health IT advisory committees have accelerated the adoption of health IT in the U.S. But, as the pushback of the industry against the proposed stage 2 meaningful use criteria shows, there is a limit to how fast healthcare providers can move on this front, especially at a time when they're also trying to cope with themove to the 5010 transaction set and the ICD-10 codes.
Moreover, there's a basic disconnect between the efforts of ONC and its advisors to use health IT to change health care and the realities on the ground. When the original draft of the meaningful use regs was released, it was clear that the health IT advisory committee had noble intentions but was going too far too fast. The requirements had to be dialed back a couple of times before vendors and providers believed they were possible to achieve -- and even then, some demurred.
The comments on the proposed stage 2 standards, similarly, have made it clear that ONC will either have to lengthen the timeline or rein in the requirements. Let's use health IT to improve the quality of care and lower costs, by all means; but let's also remember how big and behind the curve this industry is, and how many other priorities are demanding its attention. - Ken