Integrators check up on health biz

Riches await but the road is bumpy

"If we don't come up with some privacy regulations and laws that would be normalized across this country ? we're going to run into a problem on a state-by-state-by-state basis, especially on accessibility," says Kevin Hutchinson, president and CEO of SureScripts LLC

Rick Steele

Contractors are increasingly anticipating a windfall of health care IT opportunities, but several obstacles still stand in their way.

Allaying concerns about privacy, establishing trust, defining standards and deciding who will pay for health IT work are among those hurdles, industry and government experts said. Many of the opportunities for systems integrators will involve work on electronic health record systems and building a national health information system, they said.

"The technology-driven revolution is poised to reshape many aspects of health care and alter relationships of patients, physicians, pharmaceutical companies and providers," said Rick Wheeler, global government managing senior executive at Accenture LLP's government health practice. He spoke at a health care IT conference May 11 in Washington.

"From electronic heath records to RFID tags on medications to electronic prescriptions, technology is redefining the future of health care," he said. "What is less clear is how to advance these technologies in the face of some very tricky questions."

In his January 2004 State of the Union address, President Bush set the goal of ensuring most Americans had an electronic health record by 2014. As federal and state governments try to meet that goal, they along with contractors must contend with the continuing debate over privacy.

"If we don't come up with some privacy regulations and laws that would be normalized across this country ? we're going to run into a problem on a state-by-state-by-state basis, especially on accessibility," said Kevin Hutchinson, president and CEO of SureScripts LLC of Alexandria, Va. His company operates the Electronic Prescribing Network, which lets doctors and pharmacies exchange prescription information electronically.

Hurdles lined up

Political agendas and other issues get in the way of sharing information more than the technology, Hutchinson said. He also is one of 16 commissioners on the federal government's American Health Information Community, set up last year to advance electronic health records.

The Centers for Disease Control and Prevention picked Accenture, Computer Sciences Corp., IBM Corp. and Northrop Grumman Corp. to develop an architecture and a prototype for the National Health Information Network, which will feature secure information-sharing among hospitals, labs, pharmacies and physicians in three regions. The government then will adopt an architecture based on the prototypes.

The companies are working with regional health information organizations in Indiana, Massachusetts, North Carolina, Ohio and Tennessee. The four contracts are worth a combined $18.6 million.

As part of their tasks, the contractors are examining rules, starting with Health Insurance Portability and Accountability Act, which requires the Health and Human Services Department to adopt national standards for electronic health care transactions, said Brian Kelly, executive partner in Accenture's health and life sciences provider practice.

They also are polling stakeholders ? states, hospitals and health organizations ? about their regulations for sharing health records, he said. Later this year, the four contractors will issue recommendations on how to share electronic health records, he said.

Establishing trust among patients on a large scale is another potential barrier, Kelly said. The institutions that most citizens trust are their families, banks and the government, he said.

Fed leaders

The Defense and Veterans Affairs departments have led the government in establishing health record systems, Kelly said.

The Veterans Health Administration has built the Veterans Health Information Systems and Technology Architecture system (Vista), an automated system supporting electronic health records at the department's health facilities. It is supposed to be one of the best health care systems in the United States, said Robert Kolodner, chief health informatics officer at the Veterans Health Administration.

Vista lets doctors and other health care professionals view veterans' complete health records, including scanned documents, x-rays, prescriptions, wound photos and cardiology results on multimedia displays. Vista is also used by other entities, including the Indian Health Service, District of Columbia Health Department, Oklahoma State Department of Veterans Affairs and Mexico, Kolodner said.

The Defense Department's health IT priorities include information management and technology, electronic health records and joint interoperability processes, said Carl Hendricks, CIO of the Military Health System. He spoke at Federal Sources Inc.'s Annual Federal Outlook conference in April.

The department's Theater Medical Information Program captures all medical data electronically from personnel serving in combat zones. Between March 2005 and February 2006, more than 337,000 patient activities were recorded electronically, mainly in Iraq and Kuwait.

By 2011, the Defense Department will complete AHLTA, a global electronic health record system for uniformed service members, retirees and their families.

The Defense and Veterans Affairs departments can share health information through the Federal Health Information Exchange, a one-way transfer of data from the Defense Department to VA when service members leave the military.

They also can exchange real-time electronic health information for shared patients and have interoperability for computable data between the Defense Department's Clinical Data Repository and Veterans Affairs' Health Data repository.

Efforts are being made both at the national and state and local levels to establish standards for electronic records and a health care information network. Health and Human Services Secretary Michael Leavitt last June created the American Health Information Community to encourage adoption of standards for electronic health records and health IT.

As part of President Bush's 2004 health information technology plan, the group will recommend ways to provide secure information while protecting patient privacy and identifies priorities in health care information technology that will benefit patients.

It also will recommend creating standards for health care IT and a nationwide architecture for sharing health care information via the Internet. It has been tasked with proposing ways to transfer the effort to a private organization after five years.

"We need to figure out how to take data from all different sources and find a common language for it, share it and put it in a format" that all users can access, Kelly said.

Perhaps the most perplexing issue surrounding the health care IT debate is who will pay for electronic health records and a nationwide health information network. Both federal and state governments have limited funding for initiatives.

The federal IT budget for the health care line of business will have a compound annual growth rate of only 1.8 percent, reaching nearly $4.4 billion in fiscal 2007 from $4.2 billion in fiscal 2005, according to Federal Sources.

"Who's going to pay for all these magnificent advances, and how are we going to
align the costs with the benefits?" Wheeler asked.

Staff Writer Roseanne Gerin can be reached at

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