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Health Information Technology: On The Fast Track At Last?A MAJOR ANOMALY OF THE Information Age is that a huge sector of the U.S. economy has been so lacking—and for so long—in its use of information technology (IT). As dozens of major industries retooled themselves in the 1980s around new means of conveying, processing, and analyzing information, health care largely sat on the sidelines. We all suffered. How many deaths or injuries have occurred because clinicians lacked the right information about the right patient at the right time—when much or all of it could have been acted upon through the use of health IT? Just why health care lagged so badly in adopting IT is a complex story, deeply interwoven with much of the sector’s lingering cottage-industry nature. More than half of doctors still practice in groups of four or fewer physicians; not surprisingly, a survey published in the New England Journal of Medicine (3 July 2008) suggests that only about one in eight physicians have even a basic electronic record system. Despite the substantial growth of e-prescribing, as Maria Friedman and colleagues note in this volume, the vast majority of doctors still write out their prescriptions by hand. In the classic terms of a vicious cycle, the fact that health IT hasn’t been broadly adopted has almost certainly reinforced these cottage-industry tendencies—not to mention the many other failings of our health care enterprise. If you can’t or won’t share information across health care settings, the system inevitably remains much as the Institute of Medicine’s Crossing the Quality Chasm report summed up in 2001: insufficiently centered on patients, error-prone, needlessly inefficient, uncoordinated, and delivering vastly inadequate value for the dollars expended. Now the overall health IT environment is changing, if not fast enough, as this issue of Health Affairs makes clear. One measure of progress is that plans are afoot in Washington to incorporate substantial health IT investments into an economic stimulus package, in hopes of boosting the economy while building the backbone of a twenty-first-century health care system. There’s already ample evidence that these technologies can and will be enablers of massive restructuring of health care delivery. In this issue’s Report from the Field, our journalism partnership with Kaiser Health News, Carleen Hawn reports on how a small but growing corps of clinicians are tapping into social-media tools such as Facebook to communicate with patients and reorganize their practices. And as Caroline Chen and colleagues record, when Kaiser Permanente introduced comprehensive electronic health records, complete with secure e-mail messaging between clinicians and patients, primary care office visits dropped by 25 percent. Can we seriously contemplate redressing the supposed primary care shortage by adding thousands more physicians before we get similar IT systems in place nationwide? As the papers in this volume make clear, we shouldn’t embrace the likely benefits of health IT without ignoring the risks or the considerable implementation challenges ahead. Jos Aarts and Ross Koppel remind us that adoption of computerized physician order entry (CPOE) systems has been associated in some instances with unintended consequences—including, counterintuitively, more adverse drug events, not fewer. Deven McGraw and Linda Dimitropoulos and their colleagues argue that it will be critical to build public trust in health IT by addressing privacy concerns. That will be no small matter, since the combination of an unwieldy federal regulation and myriad contradictory state laws makes overall national policy on the privacy of health information a complete mess. As of this writing, even assembling a health IT piece of a stimulus package is having its problems. Years of talk about standard-setting still hasn’t produced a sure-fire path to interoperability among competing proprietary health IT systems. If the goal is to share information broadly for the public’s benefit, why should taxpayers be asked to invest more in systems that won’t talk to each other? Talk about Bridges to Nowhere, IT-style! Surely a nation that once agreed on a common standard for the width of railroad tracks ought to be able to agree on interoperability of electronic health information. But we’re not there yet. As momentum for health reform builds in Washington, addressing such concerns should be deemed every bit as important as broadening health insurance coverage or focusing on prevention. We thank the funders who made this well-timed thematic issue possible: the Markle Foundation, the California HealthCare Foundation, and the federal Agency for Healthcare Research and Quality.
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