Kolodner: Medical advances require HIT

Robert Kolodner, MD

To improve the quality of healthcare services, “we have to make it personal,” Robert Kolodner, MD, national coordinator for health IT, told his audience Monday morning at the American Health Information Management Association (AHIMA)’s 79th Annual Convention & Exhibit in Philadelphia.

“We are moving from treating to preventing to predicting,” Kolodner said during the “Federal Update” session. Our healthcare system has been so focused on chronic illness which means later intervention at a much more costly stage. Moving to a more patient-centric system will allow for healthcare rather than illness care, he said.

We are moving toward advanced knowledge of genetic basis of disease and advanced pharmacogenetics. That will require broader support for electronic information than the current silos of clinical data that do not allow for information exchange.

The Office of the National Health Information Coordinator (ONCHIT) is designed to enable consumers to maintain their own health records, Kolodner pointed out. The head position is coordinator, not commander, he added. ONCHIT’s goal is to help coordinate health data. After all, even healthy people have numerous healthcare providers who operate without knowing what the others are doing.

Efforts are underway to measure and publish price and quality of healthcare services for value-driven healthcare. Most Americans know more about the quality and value of products such as cars and television sets, Kolodner said. A robust interoperable HIT environment requires five components: electronic health records, personal health records, public health information, standards and interoperability, and a nationwide health information exchange network (NHIN).

Studies have shown that just 10 percent of physicians are using basic ordering and documentation, Kolodner said. Practices with 11 or more physicians have an adoption rate of about 20 percent. Practices of one or two physicians have an adoption rate of just 4 percent. But, the majority of healthcare is delivered in small practices. “That’s where we can intervene with chronic illnesses,” Kolodner said, but, that low adoption rate is a barrier to earlier intervention.

At hospitals, 68 percent report full or partial adoption and 11 percent have fully implemented EHRs. Only one-quarter, however, of that 11 percent say that at least half of their physicians use the electronic record system.

“We’re not trying to pour money into health IT,” Kolodner said. “There is enough money already in the system if we redirect it. We’ve hit the tipping point.”

He listed “five pieces to the puzzle:”

• Standards in HIT products.
• Privacy and security policies. A number of state laws prohibit data exchange so efforts on the state level are underway. Plus, a proposed federal framework will be presented next spring.
• NHIN as the link. Kolodner pointed out that nine HIE grants were awarded last Friday. The plan, he said, is that by next September those nine will be exchanging information freely but securely.
• Adoption of interoperable HIT.
• Governance surrounding these four pieces for coordination.

The progress to date includes certification of 92 ambulatory HER products which represent more than 40 percent of the market. Kolodner called for an AHIC successor for continuity of leadership to sustain momentum; a sustainable business model; and decisive action needed to keep pace with large-scale innovation and transformation. “HIT is foundational,” he said. “It is the key to enable us to get the quality we want and deserve.”