Health information terms

In 2004, United States President George Bush called for most Americans to have electronic health records by 2014. While few would have imagined what that really could mean to the providers of health care, patients and consumers, and those dependent on gathering health-related information from multiple sources, one thing was certain: he was not referring to electronic versions of the paper records used in most clinical settings at the time.

The types of electronic records that would support the outcomes that were and are still anticipated are part of a health information technology infrastructure that will ultimately allow authorized access to fully comprehensive patient and consumer health related information for multiple appropriate activities: patient care, consumer self-management of health, and a multitude of research, emergency response, and public health initiatives. Another part of that infrastructure is the system of health information exchange networks that can support secure and reliable information exchange within their constituency, and with other similar networks. Both the electronic records and the system of networks must, however, have incorporated recognized standards for interoperability and for the secure and reliable exchange of health information.

As of today, we do not have all the critical pieces in place to realize the vision. They are, however, just around the corner. The Certification Commission for Health Information Technology has incorporated basic interoperability standards for patient care as part of its 2008 certification criteria. Nine sites implementing the core specifications for health information exchange are the first of many that will constitute the Nationwide Health Information Network. We are on the cusp of a cataclysmic change in how health and care will be managed into the future as more and more information becomes available through expanded adoption of interoperable technologies.

Realizing the vision is not, however, just about the enabling technology. It’s also, to quote Secretary Michael Leavitt in his keynote address at the February 2008 HIMSS Annual Conference & Exhibition in Orlando, very much about sociology and culture change. Both clinicians and consumers need to feel that privacy and security needs are addressed appropriately. Everyone must see the value in creating, exchanging, and using electronic health information, and contribute to its investment. And, as in any culture, we need to clearly communicate with one another, so that our health policies are well informed, products can be marketed with transparency, and protections can be applied to well-defined situations.

Culture change requires a consistent language that can support a system of public policies, private development, and outreach/educational initiatives that will allow the majority of Americans to experience the actual value of an electronic health information infrastructure. Our next step, then, is to assure that this language is in place and represents a consensus on how terminology and definitions should be used as we move toward the 2014 goal. I am pleased that The National Alliance for Health Information Technology has convened this public dialogue and presents here the results.

Costs and Benefits of Health Information Technology

The United States health care system is at risk due to increasing demand, spiraling costs,  inconsistent and poor quality of care, and inefficient, poorly coordinated care systems. Some  evidence suggests that health information technology (HIT) can improve the efficiency, costeffectiveness, quality, and safety of medical care delivery by making best practice guidelines and evidence databases immediately available to clinicians, and by making computerized patient records available throughout a health care network. However, much of the evidence is based on a small number of systems developed at academic medical centers, and little is known about the organizational changes, costs, and time required for community practices to successfully implement off-the-shelf systems. An analysis of the usefulness of implementing HIT must take into consideration several

factors: 

• ·         The potential of this technology to improve health care quality, safety, and patient satisfactionand how this potential has been demonstrated.The cost-effectiveness of the technology—the business case for adoption of the technology including the total costs of implementation (both financial and in terms of resources) and any cost savings that accrue. Concerns exist that those who bear the greatest share of such costs are not able to recoup those costs.  

• ·         The ability to generalize the effects of an HIT intervention on costs and benefits in existing systems (using published experience with or research on these systems) to the technology’s use by other health care organizations. The Leap Frog Group and a number of components of the U.S. Department of Health and Human Services (HHS)—the Centers for Medicare & Medicaid Services (CMS), the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Office of Disease Prevention and Health Promotion (ODPHP), and the Agency for Healthcare Research and Quality (AHRQ)—requested a review of the research on HIT to compile and evaluate the evidence regarding the value of discrete HIT functions and systems in various health care settings. This  Evidence-based Practice Report on the costs and benefits of health information technology systems, along with an accompanying interactive database that catalogs and assesses the existing evidence was prepared by the Southern California Evidence-based Practice Center (EPC). This report systematically reviews the literature on the implementation of HIT systems in all care settings and assesses the evidence in four specific circumstances: 

1.  The costs and benefits of HIT for pediatric care.
2.  The ability of one aspect of HIT, the electronic health record (EHR), to improve the quality of care in ambulatory care settings.
3. The costs and cost-effectiveness of implementing HER.
4. The effect of HIT on making care more patient-centered.