Information, please: insurers expect benefits and savings from a national health technology initiative.

Key Points

* Health insurers say the newly created position of national health information technology coordinator could lead to better and more efficient health care.

* A key task for Dr. David J. Brailer will be to move the health-care system toward a common standard for electronic health records.

Health insurers are optimistic that the recent appointment of Dr. David J. Brailer as the first National Health Information Technology coordinator, along with the creation of a new unit within the Department of Health and Human Services, will be favorable for the industry.

In May, HHS Secretary Tommy Thompson announced Brailer's appointment to the position recently created by President Bush and the formation of a new office to assist in health information technology--an area Thompson said has the "potential to greatly improve health care even as it yields huge savings."

Prior to his new position, Brailer was a senior fellow at the San Francisco-based Health Technology Center, and before that he was chairman and chief executive officer of health-care management company CareScience Inc. for 10 years. He holds doctoral degrees in both medicine and economics.

"This is a significant step for the entire health-care industry, and it's important to advance the health and well-being of the entire country," said Dr. Jeffrey Kang, national medical director for Cigna HealthCare. The issue, he said, is having good information about what's going on at the point of care. "As payers now, we might through claims data only collect about 5% of what's really occurring in health care, because we get transactional information but don't get results or outcomes," Kang said. If health insurers were to get that kind of information, they could dramatically improve quality through such methods as case- and disease-management programs; improve accuracy of methodologies for payment; and provide better information to educate members, he said.

"The secretary is to be commended in taking a leadership role in this arena," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans. "We think this can have a very important impact in creating uniformity where none exists." If Thompson hadn't taken the initiative and appointed someone who is well respected in the industry, competent for the job and able to play a coordinating function, she said, the industry would likely see different languages being developed by different groups and agencies. "Instead, we'll skip over that and, with the center point of contact, we'll be able to move quicker to do the kind of things in the health-care sector that we've seen in other sectors," she said.

Leonard Schaeffer, chairman and chief executive officer of WellPoint Health Networks Inc., also said the new position and office are symbolic of the need for standardization. "Dr. Brailer will have the opportunity to leverage the entire health-care system and move it toward greater standardization and hopefully simplicity and accuracy," Schaeffer said. "And if things are done right, this could be a major step forward." He added that given the size of the government's activities, whatever standards it adopts would have a huge impact on the rest of the health-care system.

National Information Network

Brailer will be responsible for coordinating government agencies and private health-care companies in creating a national IT infrastructure. In addition, HHS said one of the new office's first tasks would be to study options to create incentives in Medicare and other HHS programs to encourage the private sector to adopt interoperable electronic health records. It's estimated that a national health information network could save about $140 billion a year through improved care and reduced duplication of medical tests, Thompson said. President Bush recently established a national goal of assuring that most Americans have electronic health records within the next decade.

Electronic health records are recommended to help ensure patient safety and care. In a 1999 Institute of Medicine report, medical errors, many of which result from providers' illegible handwriting, accounted for as many as 98,000 deaths of hospital patients each year.

Quest for Answers

"Electronic health records have been the Holy Grail for people in health care and technology for 30 years. But the devil is in the detail, and the complexities around these records are that there are confidentiality issues important to patients, clinical issues important to physicians, and technology issues," said Schaeffer. All three issues must be treated appropriately and simultaneously, which is a difficult task, he said. "However, Dr. Brailer has a tremendous opportunity and is certainly very well qualified, and I wish him well in implementing this very difficult set of issues," Schaeffer said.

Nancy Johnson, R-Conn., who chairs the U.S. House Ways and Means Subcommittee on Health, said in a statement that the implementation of a national electronic medical record system that ensures patient privacy "is the key to whether the health-care system moves forward or back."

Most health insurers seem optimistic that electronic medical records are a step in the right direction. Improving the quality of care and reducing medical errors is a positive for everyone, including health plans and consumers, said Theresa Doyle, director of legislative policy for the Blue Cross Blue Shield Association. "Electronic health records can contribute toward these goals, and we support greater use of information technology for providers," she said.

AHIP also said the records are a definite win-win for all parties. "We worked hard to make sure that there could be sharing of information across providers for purposes of treatment and health-care operations in the Health Insurance Portability and Accountability Act regulations, and so now with that in place in the regulatory realm, we now need to transition into an e-system, and we're there in the insurance industry but need to work closely with providers to make sure they make the transition as well," said Ignagni.

Also in May, Thompson announced several other new accomplishments in developing standards to help bring about electronic medical records and other health IT benefits. These include the medical vocabulary SNOMED CT, a key clinical language standard needed for a national health information infrastructure, that can be downloaded free for use in the United States through HHS' National Library of Medicine. HHS and other federal agencies will adopt 15 additional standards agreed to by the Consolidated Health Informatics initiative to allow for the electronic exchange of clinical health information across the federal government. Also, with HHS support, Health Level 7--the voluntary international health standards-setting organization--announced a favorable vote on a functional model and standards for the electronic health record.

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Cigna HealthCare A.M. Best Company # 68124 Distribution: Agents/Brokers

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