EVENT SUMMARY
“Investing in Health IT: What the U.S. and Other Countries Are Learning”
October 29, 2010
The Alliance for Health Reform, with support from The Commonwealth Fund, held a briefing at
the Columbus Club at Union Station exploring the status of health information technology adoption
in the U.S. and advances in selected other countries. The briefing provided an opportunity for
attendees to have their questions about HIT answered by a panel of experts.
Humphrey Taylor, chairman of Harris Poll and Alliance for Health Reform board member,
welcomed attendees on behalf of Senators Rockefeller and Collins, and thanked the speakers for
their participation. Mr. Taylor also thanked The Commonwealth Fund for their sponsorship of the
briefing, and noted the foundation’s ongoing contribution to global health policy.
Robin Osborn, vice president and director of The Commonwealth Fund's International Program in
Health Policy and Practice, set the stage for the following presentations by comparing health IT
usage of a number of countries. She first reviewed the how the process of health IT adoption,
including the presence of government incentives and the attitude of health professionals toward IT,
have produced a wide spectrum of outcomes internationally. Ms. Osborn then presented evidence
showing that the use of health IT in U.S. primary care practices significantly lags that of practices in
the leading countries. This is true across a range of metrics, i.e. use of computerized reminders and
discharge summarizes, prevalence of electronic medical orders and the availability of systems that
track adverse events. She noted that, despite these gaps, the U.S. has made considerable progress in
the past five years, and she expects this progress to continue.
Next, David Blumenthal, national coordinator for health information technology at the
Department of Health and Human Services (HHS), discussed how recent investments in health IT,
such as those in the stimulus act and the health reform act, are changing the health IT landscape in
the U.S. Dr. Blumenthal identified four major barriers to adoption in this country: financial
shortfalls, technical/logistical insufficiencies, infrastructure deficits and privacy concerns. He then
outlined the ways in which the HITECH Act, a part of the stimulus act, addresses these barriers. To
help overcome financial barriers, HITECH authorized billions of dollars in Medicare/Medicaid
incentive payments that will go to qualified “meaningful users” of health IT. To overcome the
technical/logistical insufficiencies, the act called for the creation of a national network of regional
extension centers to assist physicians in implementing health IT systems. Additionally, HITECH
authorized the training of 40,000 IT support personnel. To tackle the infrastructure deficits, the act
promotes the creation of state-level health information exchanges (HIEs). The Office of the
National Coordinator (ONC) has been laying the groundwork for these exchanges by issuing
regulations and certification criteria for health IT systems, which Dr. Blumenthal hopes will result in
a more stable market for these systems. Finally, he explained that the privacy and security of data are
essential to the successful adoption of health IT. The ONC has thus banned the sale of health
information without patients’ consent, increased federal enforcement activity, expanded patient
rights to access their medical information and overseen the improvement of encryption technology
to prevent security breaches. Through this multipronged approach, Dr. Blumenthal believes that the
U.S. will overcome the barriers, and will jump to high-value meaningful use of health IT as fast as
possible.
Tom Bowden of New Zealand’s HealthLink discussed the features of his country’s health system
and its use of health IT. Medical care in New Zealand is organized around primary care doctors, the
result of a strategic change in the mid-1990’s. Crucial to the success of this move was an increase in
the use of health IT. Mr. Bowden identified the collaborative atmosphere, in which business and
government work together, as key to New Zealand’s relatively effectual use of health IT. Other
features of his country’s health system that have contributed to this success include a focus on
incremental change, creating trusting relationships among all actors, fostering a constant learning
environment and building change from the bottom up. Finally, Mr. Bowden outlined two areas of
current interest for New Zealand: enabling electronic referrals and making it possible for emergency
room personnel to access general practitioners’ EMR databases in real-time.
Ib Johansen from MedCom in Denmark followed with a discussion of his nation’s use of health IT.
Unlike New Zealand, which is characterized by a decentralized network of electronic health records
housed within private GP practices, Denmark hosts a large national database of medical
information. Authorized users can log on to the database to access a patient’s record of
prescriptions, lab results, discharge letters and associated episodes of care. To ensure patients’
privacy, patients are given access to their own records, and they can monitor and control all external
requests. This database has made e-health an integral part of the Danish health system. For example,
doctors are required to offer email consultations, and their use has increased rapidly in the past
decade. Most hospitals are now completely paper-free, preferring to use electronic systems for all
orders, test results, referrals and discharge summaries. Looking forward, Denmark is focused on
improving patient access to records, eliminating wait-times for access and improving selftreatment/management of chronically ill patients.
Sabine Koch from the Karolinska Institute in Sweden next discussed the Swedish approach to
health IT. She identified some of the keys to her nation’s relative success: clinical champions and
strong administrators; collegial pressure to use the technology in primary care; the use of unique
national patient identifier; a high-tech-oriented culture; and a focus on user-centricity. One of the
biggest challenges to effective implementation has been the diversity of different, incompatible
health IT systems. Sweden has addressed this problem by encouraging market concentration.
Another characteristic of the Swedish health system is the relatively high level of social trust, such
that concerns over privacy are much less pressing than in other countries. Ms. Koch suggested that
issues of interoperability, privacy, education and quality monitoring should be central to any national
effort to adopt health IT.
An informative question and answer session followed.