Health Affairs, 24, no. 5 (2005): 1158 doi: 10.1377/hlthaff.24.5.1158 © 2005 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

This Article Extract Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content

Implementation

PROLOGUE

Implementing Health Information Technology

Hence the relevance of the following papers, which report on a rich and diverse array of initiatives to advance the IT agenda. Laments and finger pointing over a lack of speedier progress toward adoption are as common now as inflated promises of magic-bullet solutions were a few years ago. In fact, we don’t have to wait until the future to witness the prodigal impact of the information revolution in health. It is already occurring. But it consists of myriad imperceptibly small and patient steps, not a big bang. Even the major institutional initiatives that are driving change—the e-prescribing provisions in the Medicare Modernization Act (MMA), for example, or the activities of the Office of the National Coordinator for Information Technology (ONCHIT)—are proceeding by incremental stages.

Initial standards for e-prescribing under MMA were developed with remarkable speed, although Douglas Bell and Maria Friedman make it clear in the first paper that follows here that the first wave of MMA systems "may lack the advanced features needed to improve patient safety and chronic disease control." A Perspective by Lawrence Gottlieb and colleagues reviews lessons from a Massachusetts experiment with electronic sharing of information on patient medications.

On a broader scale, John Halamka and colleagues outline a collaborative strategy for coordinating local and regional information-sharing networks. These authors’ framework for policies and standards anticipates some of the strategies that have been adopted by ONCHIT, particularly the creation of a coordinating entity by the secretary of health and human services (HHS) in June 2005. The process of developing regional networks is described in case studies by Mark Frisse and by Clem McDonald and colleagues. Ed Hammond contributes an additional perspective on the standard-setting process.

Rounding out this section, David Bates examines in detail the barriers confronting primary care physicians in small practices. Wrongly painted as recalcitrant, these doctors are well aware of the advantages electronic health records could confer in outpatient care. But they face major financial hurdles and uncertainty about the standardization of products, among other deterrents, and Bates argues that public policy should aim to reduce these barriers.

                      What's this?