HHS Secretary Tommy Thompson on Wednesday released the first part of the government's plan to establish a national health information infrastructure in 10 years and bring electronic health records to every patient. The report, prepared by national health IT coordinator Dr. David Brailer, outlines the "Decade of Health Information Technology" program, a joint public-private initiative with four major overall goals and several specific actions.

"The federal government will provide a vision and a strategic direction for a national interoperable health care system, but will rely on a competitive technology industry, privately operated support services and shared investments," Thompson said of the federal and private roles under the program.

• Bring EHRs into clinical practice: The report recommends incentives for EHR adoption, shared investments for technology and changing current clinical practice to support electronic records. Low-cost support systems should help reduce the risks of changing clinical practice and operation, the report states. Technology transfer and other support can improve adoption among providers in rural and underserved areas.
• Connect clinicians: To connect health care workers and support the exchange of information for clinical decisions and treatments, the report recommend health data exchange collaborations on the local level and coordinating federal health systems to improve care, reimbursement procedures and oversight. As part of a national infrastructure, a set of tools such as mobile authentication, Web architecture and security features is needed, according to the report.
• Create more consumer-focused care: Personalizing care depends on more widespread use of personal health records, greater ability for patients to choose providers based on factors such as care quality and an expansion of telemedicine services to reach patients in rural and underserved areas, the report states.
• Improve population-based health: The report recommends integrating public health surveillance systems into an interoperable network that supports data exchange. A similar infrastructure that brings together state and local data collection efforts could improve studies on care quality and other health issues. Better information tools to accelerate research and dissemination of results are also needed, according to the report.

• Thompson will appoint a Health Information Technology Leadership Panel to assess the costs and benefits of health care IT and deliver options for intermediate steps by October.
• A private sector task force on EHR certification is currently looking into the feasibility of certifying systems for functionality, security, and interoperability. The federal government is working with the private sector on minimal product standards.
• In partnership with the Foundation for eHealth Initiative, HHS will provide $2.3 million in funding for health data exchange demonstrations projects.
• HHS will this summer request information on private sector collaborations to develop and run a health information network.
• CMS will accelerate the publication of electronic prescribing standards to sometime this year. When they are adopted, Medicare prescription drug benefit sponsors will be required to offer e-prescribing.
• CMS will establish a Medicare beneficiary portal to provide members with access to personal health information. A pilot of the portal will take place in Indiana starting this year.

The report also includes several options that HHS will examine for providing financial incentives for EHR adoption. HHS will fund up to five state and regional EHR demonstrations in FY 2004, and President Bush has proposed doubling the this funding to $100 million. The federal government could also improve access to low-rate loans for technology adoption. In addition, HHS could explore safe harbors or exceptions to physician self-referral prohibitions and anti-kickback statutes to increase IT adoption.

CMS could provide Medicare reimbursements under the physician fee schedule for the use of EHRs, based on the costs of the systems for doctors. Another option, the pay-for-performance system, would reward physicians for high quality of care. CMS could expand these programs beyond those authorized in last year's Medicare reform law.

The report was mandated in an April executive order, which also established Brailer's position. As part of the order, the Departments of Veterans Affairs and Defense and the Office of Personnel Management also developed reports on EHRs. The reports are also scheduled to be released on Wednesday (HHS fact sheet, 7/21).