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Health Information Technology Policy |
PROLOGUE
Policy Issues Surrounding Health Information Technology
In this issue Richard Hillestad and colleagues attempt to substantiate what proponents of health information technology (HIT) have long asserted: namely, that potential health care cost savings accrued through comprehensive development and adoption of a national HIT infrastructure represent a formidable weapon with which to slow soaring health care expenditures. If estimates are to be believed, the magnitude of the dollars involved is staggering. Hillestad and colleagues report that more than $81 billion could be saved through use of electronic medical records (EMRs) alone, a figure that could double through application of technological solutions in prevention and disease management. And earlier this year, in one of his last interviews as secretary of health and human services, Tommy Thompson told John Iglehart that adoption of HIT could reduce medical spending by 15–23 percent.
The recent alignment of certain political events have prompted prognosticators to proclaim the imminent dawning of a new HIT revolution. In the latest installment in the category of "strange bedfellows," presumed 2008 presidential rivals Senators Bill Frist and Hillary Rodham Clinton put aside partisan wrangling to jointly announce their recent cosponsorship of new legislation aimed at creating a national HIT network through the use of EMRs and government-developed inter-operability standards. Yet the question remains whether tectonic shifts in the political landscape are both necessary and sufficient preconditions for HIT to have the impact that technology has exerted on other aspects of daily life. Does the absence of political will, by itself, account for the failure of past predictions of impending technological revolution, and the fact that the purported promise of HIT has remained largely unfulfilled since computers were first applied to patient care solutions some forty years ago? In short, what makes this time different?
The papers that follow provide a new lens through which to view both evolution and revolution in HIT development and implementation. First, Edward Shortliffe provides needed insight into the factors that have historically obstructed progress, as well as those accounting for the latest incarnation of optimism underlying efforts to promote adoption of computer-based systems and infrastructure. Next, Roger Taylor and colleagues lay out a policy prescription intended to facilitate the realization of the substantial payoff typically associated with wholesale movement toward HIT adoption. Finally, J.D. Kleinke, accompanied by Perspectives from Tony Bower, George Halvorson, and Blackford Middleton, picks up the thread by making the case for aggressive governmental intervention to facilitate creation of a national HIT infrastructure in light of the marketplace’s ongoing failure to overcome barriers to progress.
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