Hearing Voices

June 24, 2011
Forget about the November elections. Congressional changes in leadership may have created a political upheaval, but they are unlikely to have much
Forget about the November elections. Congressional changes in leadership may have created a political upheaval, but they are unlikely to have much effect on healthcare IT projects and programs under way. If anything, it seems certain that attention to continuing improvements in healthcare will only increase.

The momentum and support achieved so far is sure to play out through newly powerful sponsors with new bills. There is deep understanding of the complexity and dynamics of the U.S. healthcare industry among elected officials in Washington, D.C. and strong bipartisan support for fixing the system. House and Senate positions relevant to healthcare are slated to be led by congressional members with long histories of interest in healthcare policy, including IT.

Other factors also point to continued progress. For one, the government, albeit reluctantly and often with an exit strategy, has assumed leadership positions to bring stakeholders and competitors to common agreement. It has taken on roles of guidance and arbitration, but it has also earmarked funding for projects.

Many of these pilots, projects and demonstrations are IT-based. They are well-established and in progress. Among them are the four contracts to develop prototypes for a national health information network under the Office of the National Healthcare Coordinator of Healthcare Information Technology. Demonstrations are planned this month.

Standards development is progressing, especially with harmonization efforts under the American Health Information Community. More than 30 outpatient electronic health record software systems have achieved certification under the first set of criteria, and acute care certification is scheduled for later this year.

Whether by mandate or proof-of-concept demonstrations, the government is moving forward with many projects heavily dependent on IT for data collection, management, sharing and analysis. A national e-prescribing standards and data sharing pilot recently ended and is expected to enable prescription automation, which is a key component of the Medicare Modernization Act of 2003. Two states, Massachusetts and Pennsylvania, have also taken leads in implementing e-prescribing.

What are the best ways to manage those with chronic conditions? No one really knows, but there may be evidence on how to proceed once the Chronic Care Improvement projects conclude. Ditto for reimbursement changes, otherwise known as pay-for-performance models, which seek to pay for outcomes rather encounters.

The mountain that is government policy is changing healthcare, but consumerism is just beginning to exercise its populist muscle. So far slow to affect change, people are beginning to speak up. And these modern consumers — patients, all — are moving beyond publicly rating their care (although they're doing that, too). They're striking back in public forums. A local newspaper article recently carried a story focused on one woman's heroic confrontation with rude office staff. Patients, one; provider, zero.

But today's consumer/patients are also tapping into new media. One Associated Press article focused on the growing use of electronic medical record systems and picked up by Yahoo! News with a related discussion board gathered both concern and opinion. There were messages of outrage, but there were also thoughtful entries about issues including system affordability for physicians, data security and privacy, and implications for insurance coverage for those with pre-existing conditions.

As costs become more transparent — and that is a government goal aimed at enabling consumers to have better choice — and as more costs shift to consumers, you can bet that consumer voices are going to get much louder.

Author Information:Charlene Marietti

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