Dawn of globalisation in health IT, Granger tells HIMSS

ORLANDO, Florida – The NHS National Programme for Information Technology is drawing interest on both sides of the Atlantic, a phenomenon that Director General of NHS IT Richard Granger calls the dawning of globalisation in health IT, writes Neil Versel.

“This is the first time someone else has done something that sits on scale with that of the US,” Granger said here at the annual Healthcare Information and Management Systems Society (HIMSS) conference this week. He called the NHS the “first international market for IT" in healthcare.

“I think the US could ignore what went on elsewhere. They can’t do that anymore," Granger said during a reception for North American companies seeking to do business in the UK.

“Many of the things we are doing will be transferable,” Granger said. “I think there is an opportunity for learning on both sides."

Granger has taken heat from the vendor community for his tough negotiating stance in awarding £5 billion worth of contracts, but he also opened the eyes of US health officials.

“They were astounded at the prices we secured and they were astounded at the pace of procurement,” Granger said, adding that Americans “have a number of vested interests that militate against common sense."

However, he defended the strategy, arguing that price, more so than resistance from techno-phobic physicians or the slow pace of innovation, has been the primary obstacle to digitisation. “One of the barriers of better healthcare, frankly, has not been the implementation of technology, but the cost of software."

For many of the 20,000 people gathered in Orlando for the largest show dedicated to health IT show in North America, acceptance of technology is accelerating, while the greatest challenges are the lack of connectivity and standardisation.

The Center for Information Technology Leadership, a research organisation affiliated with Harvard Medical School in the Boston area, made a splash, announcing preliminary results of a study suggesting that nationwide standardisation of healthcare information would save the US health system $86.8 billion in unnecessary expenses annually at the end of a 10-year implementation period.

The centre is saving specifics about its methodology for a full report it intends to sell and for an academic paper it is shopping to several journals, but others in the public and private sectors already are hard at work on the connectivity issue.

Informaticists, technology companies and HIMSS itself continued their push for standards in an effort called the EHR Collaborative. The latest evolution of the alphabet soup in clinical IT generally defines an electronic health record as a comprehensive data set, including ambulatory and acute data, as well as patient-supplied information – beyond an EMR or CPR.

“I think that this is essentially a (computerised patient record) with patient access and patient input," said 2004 HIMSS Chairman David Garets.

One in five health IT professionals surveyed by Chicago-based HIMSS between November 2003 and January 2004 have implemented some form of EMR system and another 60 per cent either are in the process of installing or have definitive plans for an EMR.
 
However, according to Pat Wise, director of the EHR initiative for HIMSS, “In this country, EHR doesn’t exist yet, but we are getting there. Everyone agrees that, done correctly, EHR will be extraordinarily beneficial to everyone, patients and providers alike,"

In his annual State of the Union address on 21 January, US President George W. Bush said, “By computerising health records, we can avoid dangerous medical mistakes, reduce costs and improve care." Members of Congress initially greeted the pronouncement with silence, but several government-directed standardisation schemes have long been underway.

“The electronic medical record is now frequently part of medical, safety, economic and political literature," according to Dr William Bria, medical director of clinical information systems at the University of Michigan and president of the Association of Medical Directors of Information Systems (AMDIS).

“Political people are starting to understand the need for standards," said Dr. Stanley Huff, senior medical informaticist at Intermountain Health Care, a hospital network in Salt Lake City, Utah.

The US government is adopting standard clinical messaging and vocabulary protocols for the publicly funded healthcare systems serving the military, veterans and senior citizens, hoping that the private sector follows its lead.

The US Department of Health and Human Services (HHS) also is advocating the idea of a National Health Information Infrastructure, a voluntary program to build a network of interconnected, interoperable data transmission systems so clinicians anywhere in the country can access complete patient records at any time.

A statute enacted late last year gives HHS until September 2005 to set data transmission, security, eligibility and safety standards for electronic prescribing for patients within the publicly funded Medicare program for the elderly and disabled.

In July 2003, HHS Secretary Tommy Thompson announced a five-year, $32.4 million deal with the College of American Pathologists to licence the Snomed CT standardised set of clinical terminology on behalf of all US healthcare organizations. Thompson also called on the Institute of Medicine – one of the quasi-governmental National Academies of Sciences – to develop an EHR standard that the healthcare industry could use as a model.

After rejecting an earlier proposal, members of standards-setting body Health Level Seven will take a second vote in March on the IOM model standard. HHS plans on making the standard freely available.

While praising the US government for taking a leadership role, some also have criticised vendors for being slow to embrace standardisation while closely guarding their proprietary software code.

“The Institute of Medicine is taking a leadership role. Vendors need to support the Institute of Medicine," Morgan said.