Partnership for Connecting Communities

 

What Problems Are We Trying to Solve?

The U.S. health care system is continuing to face many challenges, including increasing health care costs, the rising number of uninsured, and issues related to both quality and safety. For example, health care spending in the United States is expected to increase from 16% of the gross domestic product-or $2 trillion, to 20% of the GDP-or $4 trillion by 2016.¹ Quality is also of great concern to policymakers, health care leaders, and the general public. According to a study published by the New England Journal of Medicine, U.S. adults receive about half of recommended health care services.² And poor quality translates into higher costs. According to the Commonwealth Fund-sponsored U.S. Scorecard on Health System Performance, the current gap between national average rates of diabetes and blood pressure control and rates achieved by the top ten percent of health plans translates into an estimated 20,000 to 40,000 preventable deaths and $1 to $2 billion in avoidable medical costs.³

Chronic disease plays a significant role in both cost and quality in the United States. The number of Americans with chronic disease is increasing. More than 125 million Americans had at least one chronic care condition in 2000, while this number is expected to grow to 157 million by the year 2020.⁴ As baby boomers continue to age, the number of individuals living with chronic conditions will continue to increase. While 12.7% of the population during the year 2000 was age 65 or older, this number is expected to grow to 20% by the year 2030.⁵

Concerns about America's health and healthcare are also shared by consumers. According to a 2006 Kaiser Family Foundation survey, over half (54%) of American adults are dissatisfied with the quality of health care and almost a third (31%) are very dissatisfied.⁶ In addition, over 81% of Americans are dissatisfied with the cost of health care in the U.S., with a majority (56%) very dissatisfied.⁷ According to the Kaiser Health Tracking Poll related to the 2008 presidential election conducted in December 2007, health care ranks second behind Iraq as the top issue that the public wants the presidential candidates to talk about with 35% of respondents citing Iraq as the top issue and 30% citing health care as the top issue, in response to an open-ended question.⁸

The U.S. health care system is not well equipped to address growing issues around quality, safety and effectiveness in health care. Because of the highly fragmented nature of the system, information about the patient is stored in a variety of locations largely in paper-based forms which cannot easily be accessed. As a result, clinicians often do not have comprehensive information about the patient when and where it is needed most--at the point of care, and those responsible for managing and improving the health of populations do not have the information they need to measure performance and facilitate response and improvement. Most importantly, patients do not have access to all of the information they need to manage their own health and health care. The fragmentation of the current health care system results in uncoordinated care.

The introduction of health IT and health information exchange holds great promise for addressing many of the barriers to high quality, safe and more effective health care. Interoperable health IT and health information exchange--or the mobilization of clinical information electronically--facilitates access to and retrieval of clinical data, privately and securely, among different entities involved in the care delivery system, to provide safer, more timely, efficient, effective, equitable, patient-centered care.⁹

While there has been great interest in using health IT and health information exchange to address health care quality and efficiency challenges, and significant movement forward on the harmonization of and agreement on a set of standards for interoperability, health IT adoption rates continue to be low. Best estimates based on high quality surveys indicate that 24% of physician offices, 16% of solo practitioners, and 39% of large physician offices are using electronic health records.¹⁰ In addition, as noted above, while there are several health information exchange initiatives across the United States. Only 32 report that they are currently exchanging health information, and many are experiencing difficulties with achieving sustainability.

These low adoption rates are due to a number of factors, including the lack of standards adoption that would enable interoperability of health IT systems across the care system; concerns about privacy and confidentiality of electronic information; and most significantly, the misalignment of incentives, resulting in the lack of a sustainable business model for health IT and health information exchange.

Significant progress has been made to address the lack of standards that would enable the interoperability of electronic health information across the health care system. As noted above, a number of initiatives supported by ONC have made progress related to standards harmonization and certification and the work of AHIC 2.0 possibly combined with legislative efforts is expected to accelerate standards adoption. Much less progress has been made related to the financing and sustainability of health IT and health information exchange, and ultimately the lack of a sustainable business model for health IT will significantly reduce the relevance of standards-related efforts.

In fact, according to eHealth Initiative's 2007 Annual Survey of Health Information Exchange at the State, Regional and Community Levels, consistent with 2006 survey results, the most significant challenge for health information exchange initiatives is the development of a sustainable business model. This was identified as a significant challenge by more than half (56%) of respondents and an additional one-third (35%) cited this as a moderately difficult challenge.¹¹

The eHealth Initiative Foundation's Partnership for Connecting Communities Program is designed to support and accelerate the private and secure mobilization of health information electronically across the health care system to address current health care challenges related to quality, safety and efficiency, by conducting a range of activities to raise awareness of and accelerate the exchange of information across the healthcare system while protecting patient privacy, thereby creating a "business case" for the use of health IT and health information exchange.

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References

1. Centers for Medicare and Medicaid Services, 2007.
2. McGlynn EA, Asch SM, Adams J, et al. "The Quality of Health Care Delivered to Adults in the United States". N Engl J Med 2003;348:2635-2645.
3. The Commonwealth Fund. Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, New York: The Commonwealth Fund. 2006.
4. Wu S. Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Health, Santa Monica, California: RAND Corporation; 2000.
5. U.S. Bureau of the Census. Projections of the Total Resident Population by 5-Year Age Groups and Sex With Special Age Categories: Middle Series, 1999 to 2100. (NP-T3). Washington, D.C. January 2000.
6. 2006 Kaiser Family Foundation "Health Care in America" Survey.
7. Ibid.
8. Kaiser Health Tracking Poll. Information provided by the Public Opinion and Media Research Program, December 20, 2007.
9. eHealth Initiative. eHealth Initiative Second Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/assets/Documents/eHI2005AnnualSurveyofHealthInformationExchange2.0.pdf August 2005. Accessed August 2007.
10. Blumenthal D, DesRoches C, Donelan K, Ferris T, Jha A, Kaushal R, Rao Sowmya, Rosenbaum S. Health Information Technology in the United States: The Information Base for Progress. Robert Wood Johnson Foundation, MGH Institute for Health Policy. George Washington University School for Public Health and Health Services the Health Law Information Project. Available at http://hitadoption.org/downloads/annual_report_2006.pdf
11. eHealth Initiative. eHealth Initiative's 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels. December 2007.