Health Information Technology and Exchange

The landmark 1999 Institute of Medicine (IOM) report, To Err is Human, estimated that between 44,000 and 98,000 hospitalized people die each year as a result of medical errors. However, subsequent studies have found the number to be as high as 195,000.1 Between 2002 and 2004, Medicare recipients experienced more than 1.24 million patient safety incidents—295,000 of which were fatal.2 These figures make medical errors a leading cause of death in the United States. Because there are few measurement tools available, they may only be the tip of the iceberg. According to one survey, one in three people report that medical errors have affected themselves or their families.3

The hurricanes of 2005 revealed potentially disastrous gaps in our healthcare system. As years of paper medical records disappeared under water, patient information that could be critical to decisions about care was lost forever. Even in cases where records had been digitized and stored on computers, the lack of interoperability between various healthcare providers’ systems made this information nearly impossible to transmit. A small number of people could obtain their medication histories from pharmacies, but the vast majority had no access to this information at all—putting them at risk of not receiving needed medication.4

Web-based, interoperable systems allow doctors to quickly access lab, radiology and pharmacy records as well as a patient’s medical history. This information helps doctors and nurses to consider factors that a patient may not have mentioned but that could affect the appropriate course of action. Health information technology can also help to identify and communicate best practices, which allows providers to avoid making medical errors.

Much of the high cost of health care is a result of the use of unneeded or inappropriate tests. In Massachusetts, 15 percent of the state’s total healthcare expenditures went toward redundant testing, at a cost of $4.5 billion per year.5 If most of the nation’s hospitals and doctors’ offices implemented health information technology, they could save $77 billion a year through greater efficiency alone. The health and safety benefits could double those savings.6

A significant amount of activity has taken place on the local, state and federal levels on HIT and health information exchange (HIE), and even more has been done by private health systems and hospitals. In fact, many people already have electronic health records in one or more healthcare setting. It is inevitable that these systems will begin to communicate with each other, and the states must exercise their power as the largest employers and largest healthcare consumers to set the standards that shape the development of HIT and HIE. To create an effective system, states must ensure that patients—not vendors—remain the primary focus of all decisions. States must also work hard to inspire the trust of the public by guaranteeing the privacy of personal information. By passing legislation to remove barriers to data exchange, encourage cooperation between all stakeholders, and use bonds and tax incentives to foster innovation, state legislators can build a health information system that improves quality of care and lowers costs for everyone.

A 2005 survey found that 67 percent of healthcare consumers are concerned about the privacy of their personal information. Racial and ethnic minorities were even more likely to have reservations—72 percent reported privacy concerns. Fifty-two percent of the survey’s respondents expressed fear that personal health information could be used by employers to limit job opportunities. Overall, however, more than half had a favorable view of HIT and expressed willingness to share their personal information if the benefits of doing so were clear.7 Americans also support the use of HIT as a means of improving patient safety. Ninety-two percent of Americans say that the reporting of medical errors should be required. Seventy-two percent believe that the development of systems that help track and prevent errors would be “very effective.”8

Each state will have to work to develop a health information system that best suits the needs of its citizens. HIT and HIE systems will likely vary widely from state to state and region to region. Sixteen states (FL, ID, IL, IN, KY, LA, ME, MD, MI, MN, NY, OK, TX, VA, WA, WV) have passed legislation to create task forces to examine the health needs of state residents, explore systems that are currently in use in localities and private healthcare systems, listen to the concerns of employers in the state, and learn about the latest developments in the HIT/HIE field in order to make recommendations to the state.