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Health Care Information Technology

PLACE: National Health Information Infrastructure, 2003 Conference, Washington, D.C.
DATE: July 1, 2003


Thank you, Bill Yasnoff, for that kind introduction. I want to thank you and the staff of my Planning and Evaluation Office for organizing this critical conference.

Through your ingenuity and your innovation, the people in this room can transform health care in America. And I thank you all for coming.

I also want to thank Dr. Carolyn Clancy. She's just doing a great job at AHRQ. Carolyn, I appreciate what you do. And I want to thank Dr. John Lumpkin of the Robert Wood Johnson Foundation for being here and for serving as Chairman of HHS' National Committee on Vital and Health Statistics. I also want to thank John Hoff for his leadership.

My goal as Secretary is to do everything I possibly can to ensure Americans are strong, healthy, and independent. I know that the better use of technology can improve health care, and I want to make sure my Department is fully on the side of health care information that is accurate, timely, and convenient to patients, providers, and researchers.

The greatest health care system the world has ever known operates in the United States. But as great as our system is, we all know it can be even better.

One of our challenges is the explosion of new knowledge resulting from biomedical and health research, which has surpassed the ability of individual practitioners to absorb and apply it while actually delivering care. This knowledge is only as useful as the ability of a doctor to remember it when it really matters.

Recent expert reports, including "To Err is Human" and "Crossing the Quality Chasm" from the Institute of Medicine, clearly establish that practitioner experience alone is no longer enough in America to ensure safe, high-quality health care. That's where all of you come in. You are going to make it safe.

Private investors spend $32 billion every year on health care research, and taxpayers spend another $32 billion. It doesn't make sense to do all of this research but not get it to the doctors who really need it.

The Institute of Medicine estimates that 45,000 to 98,000 Americans die each year because of medical errors. Even more Americans are disabled need care to address health problems caused by medical errors.

The IOM estimates that these preventable medical errors cost between $17 and $29 billion a year. This includes the cost of disability, lost income, lost productivity at home, and the costs of additional care needed because of medical errors.

And last week, the New England Journal of Medicine published a study that measured the quality of health care delivered to adults in the United States. The study found that participants received only 54.9 percent of the recommended care they should have received. That's a very disappointing level of quality. But the data used in the study were three years old. Quality may well have improved in the past three years, but without access to current data, we have no way to tell.

We must improve the systems in which our hard working, dedicated health care professionals provide care and services. To do so, we should focus on increasing the use of informatics and other tools; enhancing communication between frontline caregivers and all members of the health care team; and using evidence-based interventions in medical care and health promotion.

One of the keys to changing the health system - and improving care, reducing errors and, over the long term, saving money - is to incorporate information technology fully into the health care delivery system.

Why is it that retailers such as L.L. Bean have been able to personalize my shopping experience and yours - automatically providing the correct sizes and suggestions of other items based on what I bought last year - but my doctor and pharmacist cannot quickly refer to a list of my prescriptions or see when I had my last physical?

The answer, of course, is that retail companies have data systems that track this information and make it available to me and to the customer service people who are helping me.

This is the retail equivalent of the electronic medical record, and even having that in place across the country would be a great leap forward from where we are today.

But medical history is only one kind of useful information. There is also an overwhelming amount of new scientific information and data on effective interventions that should be informing the day-to-day decisions of health providers, but which is simply unmanageable to incorporate into the 20-minute office visit without some help from electronic aids.

I am very excited about the tremendous potential for information systems to improve the quality of health care, and I have been pushing everyone in the Department very hard to move forward as rapidly as possible. I tell my managers in the Department: if you're not living on the edge, you're taking up too much space.

We need your expertise, your energy, and your commitment to get the job done.

Health care professionals need to be able to reach information about a patient anytime, anywhere so that they can effectively and safely treat that patient.

We need a health information system that will reduce errors. Our doctors make more decisions in the exam room than pilots make when landing a plane - yet we provide pilots with scores of instruments and warning systems to prevent errors. We must give our health care professionals the tools they need to detect and prevent errors - before they happen.

We need a health information system that will improve quality. Our biomedical research is the envy of the world, but even our best hospitals fail to give some patients the latest treatments, years after they've been proven appropriate. NIH says it takes from 10 to 17 years for new discoveries to be routinely used. That's shocking.

We need a health information system that automatically gives health professionals access to the patient-specific medical knowledge required for diagnosis and treatment - the latest research results from medical journals, the most up-to-date guidelines, the appropriate public health notifications. Our doctors then will not have to depend on their great memories any more.

We need a health information system that empowers consumers - that allows them to communicate with their doctors electronically, to receive their own test results, perhaps even to record what they eat and when and how much they exercise.

We need a health information system that can do all these things regardless of where the physician and patient are - so that an illness or injury while traveling can be handled as safely away from home as it is at home.

And we need a health information system that allows public health officials to detect patterns of disease - so that outbreaks and bioterrorism can be spotted early, when interventions can save lives and prevent further spread of disease. We have seen how important this has been in the last several years: anthrax, the West Nile Virus, SARS, and monkeypox. But we need to be able to respond even better.

We can have such a health information system and improve efficiency at the same time.

We know that lack of timely information creates huge, unnecessary costs - unnecessary tests, unnecessary x-rays, unnecessary doctor visits, even unnecessary hospitalizations.

A good information system can save at least $100 billion a year- and probably more.

When I talk about this, many people say it's just a dream - it can't be done, it's too difficult. But it's already happening - today - thanks to individual initiative and community leadership.

In places like Santa Barbara County in California and the Regenstrief Institute in Indianapolis, communities are sharing health information electronically and demonstrating improved safety, increased quality, and lower costs.

In the federal government, the Veterans Administration and the Department of Defense have been leaders in applying information technology effectively in their health care activities.

We know it can be done - because it is being done.

But it's too slow and too scattered. It's only being done in a few places where there are committed community leaders with high levels of expertise - and a lot of persistence. We need to develop our health information systems everywhere - not in just a few places. And we need to do it now.

Health care markets need to develop and adopt more advanced information technology.

But HHS can and will help lead on this effort. We will continue providing leadership and assistance. We will help introduce needed standards. We will continue funding research and demonstration projects. We will continue promoting free-market efforts. We will work with you. We're going to get this football down the field.

At HHS, we have already taken a number of key steps. Let me tell you about some of those:

  • The FDA has proposed a new rule for bar coding medications. This will improve patient safety by allowing information systems to reduce preventable medication. This new rule is in response to what we know from our own research. It also reflects the advocacy of partners like the National Coordinating Council for Medication Error Reporting and Prevention, the Veteran's Administration, and the American Hospital Association.
  • I announced in March that the federal government has adopted five key health information standards. These standards were developed in the free market, and will be used by government agencies for their own health information systems. We expect that government use of these standards will encourage the free market use of them as well.
  • To improve our understanding of the limitations of new drugs, we proposed standardizing reporting formats and standards for adverse events resulting from the use of approved drug and biological products. The reporting standards will allow the collation of data from the United States, Japan, and many European countries. The improved timeliness and quality of the safety reports are going to make it possible for manufacturers and regulators to take corrective actions more quickly and help consumers make more informed decisions about treatments.
  • The President has requested at least $65 million for NHII for 2004: $50 million for AHRQ demonstration projects to show how patient safety is enhanced by information technology, $12 million for ASPE and AHRQ to support development of standards, and $3 million for NHII coordination.

Most important, I am very happy today to be able to announce some exciting new steps that HHS is taking improve patient care and reduce the burden of high costs and the pointless harm of medical errors.

First, we're making a common medical language available to all members of the health care community. We have signed an agreement with the College of American Pathologists to allow free use of its standardized medical vocabulary system, SNOMED.

This wonderful, groundbreaking agreement will improve quality of care for Americans by enabling providers and every member of the health care community to communicate electronically with each other regarding care provided in physician's offices and other settings. And we're going to make it available without cost to you and to all health care organizations and information system vendors throughout the United States.

You may ask why we're providing it for free. We're providing it for free because we want you to use it.

I want to thank Don Lindberg and Betsy Humphreys of the National Library of Medicine for this momentous accomplishment. In fact, SNOMED will be distributed by the National Library of Medicine through its Unified Medical Language System.

I am also pleased to announce today that I have asked the Institute of Medicine to work with HL7 to design a standardized model of an electronic health record. HL7 will be validating this model. In cooperation with the Veteran's Administration, we have asked the HL7 standards development organization to evaluate the model once it has been designed. I urge all of you to participate in that validation process. We need your practical experience to produce the best possible product.

I have no intention, however, of stopping there. I know that yesterday, John Lumpkin showed you a chart of all the HHS agencies that touch on NHII. That's why I created a new HHS Council on the Application of Health Information Technology to coordinate all those agencies' Information technology efforts, and ensure they are promoting rapid development of a paperless system.

My first charge to that council is to develop incentives for all parts of the health care community to use SNOMED, the electronic medical records, and other standards as they are adopted. We want to see the integration of health information systems through to its logical conclusion.

These are just some examples of information initiatives. There are others underway, and many of you here today have been asked to advise and participate in them and in other equally important initiatives and studies. I want to thank you for your contributions, and ask you to continue advising us in your areas of special expertise and technical knowledge.

I challenge you to adopt and use interoperable electronic health records. So much more still needs to be done.

The government cannot fund all the information technology in health care, and it shouldn't - the free market must do some of it. However, we can do at least two things:

We can give it a push to prove its value. I want to create a financial assistance program to help health care organizations modernize and upgrade to interoperable health information technology.

We will also be working with all these partners to develop and track measures and benchmarks to assess progress on the NHII - to hold all of us accountable for doing everything we can to accelerate the introduction of IT. We expect to convene more meetings like this one in the future.

Disease management is an exciting new field of care that we support and encourage. It can improve health and save money. And information technology can help here, too. A patient with a chronic disease might stick his finger into a home machine every day, knowing that his blood sugar levels would be instantly transmitted to his doctor. Armed with this current data, the doctor could send advice to the patient, and know when to call him in for a checkup.

A patient can also carry a chip containing his medical records. Every doctor or pharmacist he visits can review and update his medical history. Some people will even have such chips implanted in their skin.

I look forward to a day - not too far away - when our 21st century care is supported by 21st century information systems. This meeting is a giant step toward that goal.

The United States cannot reap the full benefit of technology for health improvement unless we exploit technology's great potential to provide direct assistance to patients, family caregivers, and health care professionals.

We can only get there if everyone in this room joins the effort.

I hope that through conversations initiated at this meeting, each of you and your organizations will become more comfortable and confident in articulating your roles in achieving an efficient, effective, modern health system. Then I hope you will work with us in HHS to see what we can do to collaborate with you to help create an environment that allows you to pursue the kinds of creative and innovative solutions that America needs.

My hope and expectation is that this meeting will point out both promising areas for immediate action, as well as directions for future exploration and research. I encourage you to take what you learn here and put it to work when you return home to your communities and the organizations where you work, as I know you will.

Patients and their families, as well as health care providers throughout the nation, are counting on all of us. Looking around the room, I know that their faith is well placed.

By improving the flow of information and knowledge, we can improve the health and well-being of all Americans.

Thank you.