Letter to State on Health IT

Dear Dr. Newton:

The work of the Iowa e-Health Project is very important. Thank you for your leadership. The use of health information technology (HIT) holds much promise to improve health care while driving out cost and increasing quality and transparency. It may be as revolutionary or more so in health as information technology has been in the banking and finance industry.

As you know there is now a major push underway across the U.S. to deploy this technology triggered by the American Recovery and Reinvestment Act. National health reform, in all of its current options, contains emphasis on HIT as well. With such a major push to deploy the technology, there is a risk of overlooking a key piece of the overall strategy. Standardization is much easier to achieve at the onset of a technological shift than later when there are many installed systems in place that require retrofitting.

Health information technology has many dimensions in terms of its promise for improvement as well as in its application. While the initial application may be through health care providers, it is very important to involve all major stakeholders from the beginning and to create a vision with goals that encompass the full potential and use of health information technology.

Given the above, we want to communicate important priorities and issues we have determined so far as representatives of Iowa consumers and purchasers. While the initial focus is rightly on health providers and their systems, it is essential that all dimensions and interests be included in the planning process now and as deployment moves forward.

From our research there are three dimensions of HIT necessary in order to unlock its potential and all three should be planned for now as Iowa moves forward:

  1. Electronic health record (EHR) systems used by health care providers.
  2. Personal health record (PHR) for each patient with the essential goal of one PHR for each person across all health care providers so a complete record is available, and that record should be owned by that person (the consumer). We recommend that the State explore the concept of Health Banking to accomplish this goal.
  3. A layer of infrastructure and standards (such as regional health exchanges) to enable population level analysis which supports implementation of evidence-based medicine, helps reduce costs, enhances transparency and supports CQI. All three are key components and are interrelated. Only through cost and quality transparency will we be able to tap into the power of the consumer and realize real health transformation.

In addition, we want to point out the following key priorities/issues:

  1. Assure patient confidentiality, privacy and security.
  2. Enable patient access to their health information.
  3. Allow patients to contribute key information to their health record.
  4. Realize the potential of patient-centered care.
  5. Support CQI and evidence-based medicine.
  6. Increase provider performance measurement and public reporting (transparency).

We encourage and recommend that the State of Iowa include theses dimensions and priorities as the State Plan is updated and in the work of the e-Health Project. We stand ready to be of assistance.