Impact Of It On Healthcare: Development Of A Nationwide Health Information Network

The United States spends 16% of its GDP ($1.9 trillion in 2004) on healthcare, far more than any other nation, and yet indicators suggest healthcare quality is deteriorating. In addition, there are over 46 million people in the United States that are uninsured. In an attempt to improve quality and reduce costs, many healthcare providers are turning to electronic health records (EHR). As of 2005, it is estimated that 20% of hospitals and 10% of doctors' offices have adopted EHR. The first two sections examine the challenges faced by the US healthcare industry and barriers to electronic record adoption.In 2004, President Bush called for a national program to allow a majority of Americans to have interoperable electronic health records by the year 2014. A new office was created, the Office of the National Coordinator for Health Information Technology (ONCHIT). The principal aim of the office is to incubate a Nationwide Health Information Network (NHIN). The goal of the NHIN is to (1) avoid medical errors since providers will have a more holistic history of a patient before taking a course of action, (2) reduce health costs by minimizing redundant tests and the time required by health providers to collect a patient's history and (3) improve access to health information so patients have more and better alternatives. A NHIN would also decrease current access barriers to health information, resulting in healthier competition between providers.With input from the healthcare community, the ONCHIT considered various NHIN implementation alternatives and is currently focusing on fostering Regional Health Information Organizations (RHIOs), which would become the building blocks to a NHIN. RHIOs are growing fast since the ONCHIT set forth its vision for the NHIN. There are over 137 early-stage exchange communities formed, of which 14 are recognized and funded RHIOs. However, only three RHIOs are deemed functional. Challenges faced by RHIOs include securing funding, developing sustainable business models, and recruiting a critical mass of health providers to participate in the network.The authors predict EHR adoption will continue slowly, hindered by lack of standards and weak incentives for smaller healthcare providers. They predict most RHIOs will not reach a critical mass because of slow EHR adoption, lack of funding and sustainable business models, and relatively weak incentives for hospitals and doctors to join. Finally, they predict it will take 10–20 years longer to reach 50% adoption on a NHIN than the current 2014 target that the ONCHIT is optimistic about. The prediction of a slower adoption is based on comparing NHIN to other IT standards' adoption rates, weak adoption of NHIN pre-requisites (EHR and RHIOs), and privacy barriers. To speed up the adoption, the authors recommend the ONCHIT take four actions: (1) increase ONCHIT focus on setting "network-compatible" EHR standards, (2) work with the U.S. Department of Health and Human Services to use influence gained from controlling Medicaid and Medicare earlier rather than waiting until 70% adoption, (3) financial incentives for the private sector to establish RHIOs and the NHIN and (4) work with state governors to focus on initial state implementations.