|Implemented in this survey?|
In April 2004, President Bush announced his intent to provide Americans with electronic health records by 2014. The Office of the National Coordinator for Health Information Technology (ONCHIT) was established within the Department of Health and Human Services to develop and implement a strategic plan to guide this effort. This report provides an update on the progress of ONCHIT and HHS in meeting the President's objective.
In July 2004, the Office of the National Coordinator for Health Information Technology (ONCHIT) and the Secretary of Health and Human Services (HHS) released the Framework for Strategic Action, which outlined 4 goals to advance the President's objective of providing Americans with electronic health records by 2014. The Government Accountability Office has been tracking the progress of ONCHIT and HHS. The following is a description of key actions and progress:
Goal 1: Accelerate adoption of EHRs
Goal 2: Build an interoperable health information exchange infrastructure
Goal 3: Personalize health care by promoting Personal Health Records and consumer choice
Goal 4: Improve public health surveillance systems
In 2005, the Secretary of HHS commissioned a Federal advisory body, the American Health Information Community (AHIC), to provide recommendations to HHS on achieving the President's goals. In 2008, the AHIC will transition into the private sector.
HHS has also taken several steps to address privacy and security issues. For example, HHS has awarded contracts to 33 states and Puerto Rico to perform an assessment of state laws concerning privacy and security, and how they will affect the implementation of an interoperable health information exchange. However, the GAO found that HHS has not yet developed a comprehensive national strategy concerning privacy and security.
Financial and non-financial.
Providers, consumers, congress, insurers
|Medienpräsenz||sehr gering||sehr hoch|
EHR adoption in the United States lags behind that of other industrialized countries. Federal leadership is essential to accelerate adoption, but must be accompanied by funding to assist providers.
President Bush's goal of providing EHRs to Americans by 2014 is part of a national Technology Agenda to promote innovation and technology. Despite the known benefits of EHRs, their adoption in the United States has been slow compared to other countries due to high implementation costs for physicians, benefits which accrue mainly to payers and purchasers, and lack of interoperability. The strategies developed by ONCHIT/HHS address some of these barriers.
President Bush's Technology Agenda
|Implemented in this survey?|
The health care system in the United States faces several challenges including preventable medical errors, variations in health care quality, and administrative inefficiencies. President Bush's Technology Agenda was motivated in part by the recognition that HIT is an important tool in addressing many of these problems. Benefits to the consumer include reduction in medical errors, decrease in paperwork, higher quality care, and better access to personal health care information. The public health system will benefit from improved disease surveillance, quality measurement, and evaluation of programs and interventions.
The goals of the President and HHS build on previous recommendations and projects by the Institute of Medicine, the National Committee on Vital and Health Statistics, and private foundations such as the Markle Foundation and the Robert Wood Johnson Foundation.
The approach of the idea is described as:
renewed: Public and private organizations have previously recommended implementing electronic health records.
Pilot project - In addition to this federal initiative, advances are also occurring at the State level. Massachusetts recently partnered with Blue Cross/Blue Shield in a $50 million effort to implement EHRs in 3 cities.
Following President Bush's announcement, the Secretary of HHS and the National Coordinator released a report, "The Decade of Health Information Technology: Delivering Consumer-Centric and Information Rich Health Care - A Framework for Strategic Action". Congress and other stakeholders were supportive of this report.
|President of the United States||sehr unterstützend||stark dagegen|
|Congress||sehr unterstützend||stark dagegen|
|Physicians||sehr unterstützend||stark dagegen|
|Hospitals||sehr unterstützend||stark dagegen|
|Insurers||sehr unterstützend||stark dagegen|
|Consumers||sehr unterstützend||stark dagegen|
The Wired for Health Care Quality Act 2005 was introduced and passed in the Senate, but could not be reconciled with the House version. The bill was reintroduced in the Senate in June 2007. It would codify the position and office of the National Coordinator for Health Information Technology. However, several features of the bill are not supported by the Bush Administration. In a letter to the Subcommitte on Health, Education, Labor, and Pensions (HELP), Secretary Leavitt opposed among others, retaining the AHIC in the public sector, and providing grants and loans to assist providers in adopting HIT. HELP has passed the bill, and it will now be considered by the full Senate.
|President of the United States||sehr groß||kein|
The Wired for Health Care Quality Act 2007 will require that ONCHIT develop performance measures to evalute its progress. Recent GAO reports have found that ONCHIT currently lacks these measures.
While progress has been made in several key areas, the GAO found that ONCHIT lacked detailed plans and performance measures needed to ensure that the President's goal will be met by 2014. It is unclear whether this goal will be achieved, or what can be expected by 2014. In addition, analysis of both the 2005 and 2007 bills by the Commonwealth Fund suggests that the funding required to accelarate the widespread adoption of HIT in the United States continues to be insufficient.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
There is growing evidence that electronic health care records can improve quality, improve efficiency, and control costs. This policy can have a significant impact on the U.S. health care system.
Petigara, Tanaz and Gerard Anderson
Johns Hopkins Bloomberg School of Public Health