Stimulus Package Pushed Health IT Forward, but Implementation Needs More Thought

Smith asked the audience to consider Internet companies Amazon and Open Table, which are both “new things in the world. … Amazon is not Kramerbooks with a computer.” Open Table is an online restaurant reservation service, Kramerbooks is a Washington bookstore and cafe.

So too, technology can allow health care to create entirely new services that can’t be imagined today, he said - - but only if certain policies get out of the way. Reimbursement must be changed so doctors aren’t chained to the payment paradigm of the per-office visit, he said. Comparative effectiveness research must be changed to develop a data system that works in real time, rather than producing isolated research-only data streams, he said. And regulations that protect incumbents must be updated, he said. If IT is limited to the needs of the incumbents, then “what we'll be doing is giving Kramerbooks a computer,” he said. Doctors and hospitals do need to be wired, he said, but doing so shouldn’t constrict innovative possibilities. There needs to be room for new platforms and developments, he said. Someone could construct an Open Table type service, he said, that would bring “Kaiser-ness” to small, non-Kaiser Permanente physicians, Kaiser being a massive health system that has already achieved economies of scale with its EHRs and PHRs.

Google took a few indirect hits during the discussions, which included panels on privacy and industry perspective. Neal Patterson, CEO of health IT provider Cerner Corporation, said no one wants to talk about how patients would be correctly identified in a nationwide electronic system. There are people “in this room,” he said, as he sat next to Google Vice President Alfred Spector, who think it can be done with algorithms. “You guys are the best” at creating algorithms, Patterson said, but when it comes to matching the correct medical record to the correct person, “that will be a mistake.” But Spector and Microsoft Vice President Peter Neupert didn’t disagree with Patterson’s assessment. Patterson’s right about algorithms, Neupert said. Whether the public would accept another solution, like national medical numbers, is another question, he said. And even nations that have national IDs experience problems, he said. “Just having the ID doesn’t solve the problem,” he said.

Google, which has been quoted in the press saying it doesn’t believe HIPAA provisions apply to its PHRs as a result of the stimulus bill, also found itself in the spotlight when Deborah Peel of the Patient Privacy Rights Foundation highlighted the company’s quote on a slide. “Every time we try to draw a boundary, somebody’s going to technically weasel out of it,” she said. Whether the language of the stimulus bill applies to Google, the intent of Congress to protect data was clear, she said. Others, though, like Deven McGraw of the Health Privacy Project at the Center for Democracy & Technology, have said protections for PHRs, which are controlled by consumers, should look different than protections for EHRs, which are controlled by the health care providers. McGraw said consent is critical but not sufficient as protection for PHRs. There will need to be an enforceable floor of protections, she said, most likely not under HIPAA, which is geared to medical providers and their associates.

Panelists also warned of letting standards-setting and harmonization slow the process of adopting health IT. Neupert said Microsoft’s Health Vault can connect disparate systems even without complete harmonization. “We can start to make that happen today,” he said. Spector, too, said Google’s PHR would allow patients to connect their providers in an ad hoc manner. Someday, Spector said, all doctors might be connected and able to exchange information, but until that day comes, patients can step in. Perfect standards aren’t needed to begin organizing data, he said, but the more standards there are in the end, the better.