Health Information Technology: United States Health Care & Electronic Health Record System Information from Accenture

After years of mostly ineffective talk, the forces are now aligned for the successful implementation of health information technology (HIT) and the electronic health record (EHR) in the United States.

Both public and private health sectors agree on the need, and the only differences of opinion are as to the degree of their value. Given the massive size of the health care sector in our economy, as well as the complexity of the task, there is no short cut. Success is likely to take at least seven to 10 years. The challenges are significant, especially in the highly decentralized health care system in the United States, and cooperation will be voluntary, not mandatory. But what have been insurmountable barriers to success in the past are now seen to be challenges that can be successfully addressed by all of the individuals and organizations affected.

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In the spring of 2004, President Bush established a vision of interoperable electronic health records within 10 years and appointed David Brailer, M.D., Ph.D., to serve as the National Coordinator for Health Information Technology. A recent publication by Health and Human Services Secretary Tommy Thompson and Dr. Brailer established four overarching goals: informing clinical practice; interconnecting clinicians; personalizing patient care; and improving population health, including access to care for underserved Americans.

Executives within the health industry have long acknowledged the inherent societal good of fostering technology adoption and applying health information technology to the clinical environment through electronic health records. HIT and EHRs in particular offer the potential for improved patient safety and reduced medical errors, as well as lower administrative and medical costs.

But the barriers to implement these technologies are high, and the immediate tangible benefits to health organizations remain elusive. As a result, development of EHRs in the United States has been extremely slow and lags behind many other countries. The federal government has issued its call for action, but many unanswered questions remain.

Information technology in health care has made great progress in diagnostic and therapeutic applications. However, the application of HIT to clinical records (the EHR) has been dreadfully slow. The ability for different providers and organizations to electronically store and then exchange health-related information anywhere that a patient needs care does not exist, and looks likely not to exist, unless significant coordinated efforts are undertaken by all parties in the health industry.

None of the disparate EHR systems currently in the market are capable of communicating with each other in any but the most rudimentary ways, if at all. Even two or more implementations of the same vendor's EHR product for the most part cannot be made to communicate with each other because choices such as differing vocabularies and code sets that were made during each EHR system's implementation preclude communication.

Health care IT executives believe that increasing patient safety/reducing medical errors is among the top business issues that will have the most impact on health care in the next two years. They consider clinical information systems, electronic medical records and computer-based practitioner order entry—all of which can have a significant impact on reducing medical errors—to be among the most important applications their organizations will need to invest in over the next two years.

There are significant challenges facing a shared EHR. It is worthwhile to look more closely at some of the issues related to HIT research, planning and implementation since an inability to address them will surely hinder adoption of the EHR. These issues are structural, technical, financial, and social/cultural challenges. None of these challenges represent insurmountable barriers to a successful national adoption of HIT or, specifically, shared EHRs. On the other hand, understanding these challenges is the first step to resolving them.

The adoption and implementation of HIT and the EHR in the United States will be a long-term process. Progress will occur over the next 10 years and will continue to evolve even after that. At this early stage in the strategic formulation of a national HIT agenda, it is difficult to predict what the specific results will look like. Given the "ground-up" approach that is being adopted, the details are likely to vary from region to region, at least in the near term.

What is clearer is what the process will look like and what issues will need to be addressed. To accomplish the strategic goals that have been established, the process will need to address existing barriers such as funding for capital outlays, incentives to encourage physician adoption, collaboration between health industry constituents, and standards to facilitate easy exchange of data from one computer system to another, or interoperability.

Accenture has identified a number of steps that hospitals and health plans should begin to put in place to secure their leadership positions in local market-driven health information networks. These steps can help lead hospitals further on their journey toward high performance:

• Begin a community dialogue on electronic health records.
• Start developing an IT infrastructure to support the processes of the advanced clinical information system.
• Engage physicians in the process of preparing for electronic health records.
• Start to engage local governments to help with local infrastructure creation.
• Redesign clinical documentation workflows by working with physicians and staff.
• Define and establish the service levels.
• Conduct a thorough assessment of patient safety.
• Conduct a thorough assessment of patient access.
• Establish a delivery and support model.
• Ensure compliance with privacy and security regulations.
• Develop a business case to guide the electronic health record development process.

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