Commission strives to aid national e-records adoption

Delay in implementation by the federal government would send the wrong signal to the private sector, HHS chief says.

A commission on Tuesday made more than 30 recommendations in an effort to meet the national goal of widespread adoption of electronic health records by 2014.

Health and Human Services Secretary Michael Leavitt stressed that time is of the essence to find short-term health information technology applications to produce tangible results for consumers.

The recommendations range from HHS-endorsed standards for laboratory data to establishing criteria for securing technologically compatible messages between doctors and patients. Leavitt, who chairs the American Health Information Community, had set Tuesday as the deadline for its working groups to make attainable proposals.

To foster the adoption of e-health records, a working group recommended that a health IT panel endorse standards for commonly used laboratory results by October. There is a March 2007 deadline to establish software certification criteria for e-health records.

But when the group said federal agencies that provide direct patient care should develop a plan to integrate those standards into business practices by the end of the year, officials from the Defense and Veterans Affairs departments said that deadline is unrealistic.

Another recommendation for federal agencies to include the adoption of such standards in their business contracts related to health care also was met with resistance by agency officials.

Assistant Defense Secretary William Winkenwerder urged the group to "proceed with caution," given the department's more than 200,000 contractors. Moreover, transitioning to a system to integrate standards immediately could be cost prohibitive. But he said the terms of contracts to be awarded in fiscal 2009 should be set within the next 18 months, at which point any modification could be included.

Leavitt warned that a delay in implementation by the federal government would send a wrong message to the private sector.

The Office of Personnel Management, meanwhile, said it already has notified its health insurance carriers they are expected to adopt standards as they are deployed. "I don't anticipate any problem of keeping up," OPM Deputy Director Dan Blair said.

The commission agreed that HHS should issue guidance on whether any changes in current laws are necessary to achieve information sharing while also maintaining privacy.

Taking lessons from Hurricane Katrina, which left nearly a million people without medical records, the group suggested that HHS create a basic template for patients to create records. The template includes medication histories, allergies, diagnoses and advanced directives in an effort to assist emergency responders.

Another group recommended that HHS develop the regulatory environment for clinicians to be reimbursed for remote communications such as secure messaging with patients. The group said HHS should work with state agencies to develop licensing alternatives so doctors could provide electronic care across state lines.

HHS also was encouraged to conduct demonstration projects within the next six months to measure the value of e-registration forms and medication histories with chronically ill patients.

The biosurveillance group, meanwhile, called on HHS to develop sample agreements for state and federal health agencies to share data by September.