How are the hospitals doing? The American Hospital Association is complaining that they have too many requirements and regulations to comply with.
It is more difficult for hospitals, but there is a huge level of engagement on their part. Ninety percent of hospital CIOs say that getting to “meaningful use” in the next two years it a top priority. We’ve hit the balance of making it achievable, even though it’s ambitious. This is hard. Change is not always easy.
Is there evidence that all of this is having an impact?
In about 18 months we expect to have data from specific study areas. We have established 17 “beacon communities” that form a microcosm of America, from Mississippi to Maine. These “beacons” are clusters of health-care providers that have done pioneering work on using health-information technology to improve care. They are rigorously measuring indicators around quality, safety, and cost. A lot of them are looking at diabetes care—cost and quality of care—some are looking at issues like childhood asthma.
What about the $2 billion you are spending on “health information exchanges,” wherein hospitals are supposed to start electronically sharing patient data with each other?
We’ve done important things; the standards and protocols for sharing data are in place. But the problem with information exchange is not the technology—it’s around the business case. All of a sudden we are seeing [hospitals] waking up and saying, “Uh-oh, the game isn’t about me keeping information to myself so patients come back to me, it’s about accountable care—because I don’t want another emergency department to repeat the CT scan I gave.” People are seeing it’s in their own financial interest to do the exchange. We are reflecting this concept in regulation so that you can’t use information to lock in patients by locking in their data.
How are you going to get patients to play a bigger role in their health care? We recently witnessed the shutdown of Google Health, which was built to let people import, analyze, and manage such data.
The failure of Google Health was partly due to the difficulty people had in getting their data into the system. All too often, people had to spend hours typing it in—so it became a glorified word processor. But Google Health was a call to arms that says people have a right to their health record. A lot of institutions don’t make it easy. Part of this is about let’s change that, let’s reverse that—let’s make it easier.
Is some new and more patient-centric federal effort coming?
Stay tuned. What we can do is lead, convene, put out a call to arms, and set standards. We can include patient access as a “meaningful use” of electronic records. Ultimately, it’s going to have to be patients and providers getting across the idea that—as someone put it—the most underutilized resource in health care is the patients themselves.