How Massachusetts can lead health IT modernization

Although healthcare reform has its supporters and detractors, healthcare IT reform – the use of technology to improve the quality, safety and efficiency of healthcare throughout the country – has broad support from all stakeholders.

The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use and the manufacturing of healthcare IT systems, this could translate into over a $1 billion for the Commonwealth of Massachusetts.

This isn’t a “cash for computers” program though – it’s much more than that. The stimulus bill was crafted very wisely. It’s not a field day either for the doctors and hospitals who would receive these funds, or for the vendors selling this hardware and software. That’s because in order to get these dollars, physicians and hospitals have to not only buy the new systems, they have to prove that they’re using them to improve care before they’ll qualify to get any money back from the government. What does it mean to improve care? The requirements are actually quite specific and include: improving care coordination, reducing healthcare disparities, engaging patients and their families, improving population and public health, and ensuring adequate privacy and security protections.

The health IT modernization program promotes the use of advanced tools which could significantly improve the quality and efficiency of healthcare in the country today. Massachusetts is well positioned to lead this charge.

The genius of the program is that it is carefully tailored to fit our uniquely American economy and culture. We are a society that prizes individual initiative and rejects “top-down” solutions, and no other part of the economy is more reflective of that than health care delivery. We also believe in the power of markets to allocate resources where they’ll create the most value and to drive innovation that improves peoples’ lives. So unlike other countries where the government is creating its own infrastructure and dictating which systems the medical community must use, the Obama Administration’s health IT program uses federal dollars to give an adrenaline boost to the market.

It does this in three ways: incentives to providers who use IT to achieve higher quality, lower cost care; non-proprietary strict standards to create a level playing field for users and sellers of software and hardware systems; unbiased certification of software to provider assurance that it meets basic quality, safety, and efficiency standards.

Incentives. Medicare and Medicaid have defined 25 basic projects that each hospital and clinician office must complete to demonstrate that they have embraced technology to improve care. For example, medications must be electronically ordered, checked for safety, and routed to pharmacies – going from the clinician’s brain to the patient’s vein without paper or error-prone handwriting. Massachusetts is already the #1 electronic prescriber in the country and has been for the past 3 years. Even so, less than one-third of all prescriptions in the Commonwealth are transmitted electronically today. Fortunately, all of our regional health plans have been champions of e-prescribing, as have all of our major provider groups. Multi-stakeholder partnerships such as the New England Healthcare Institute, Massachusetts Health Data Consortium, and Massachusetts eHealth Collaborative have focused on medication safety. So even though we’re ahead of the pack, we still have a long way to go. The federal health IT program will provide a valuable boost to all of these efforts.

Standards. Well-defined precise electronic formats are needed to share data in our communities with patient consent. For more than a decade, Massachusetts has been a leading state in the secure exchange of patient data via the New England Healthcare Exchange Network (NEHEN), SafeHealth, Community Hospitals and Physician Practice Systems (CHAPS) and the Northern Berkshire eHealth Collaborative sponsored by the Massachusetts eHealth Collaborative. Massachusetts is also a national leader in providing patient access to their medical records through such programs as PatientSite, PatientGateway, myHealth Online, and Indivo Health and providers and health plans making their data available to GoogleHealth and Microsoft HealthVault.

Certification. Medical software, like any other technology that directly impacts public safety, must conform to basic testing and certification to ensure it has the capabilities needed to improve quality, safety and efficiency in hospitals and offices.

Incentives to physicians and hospitals adds fuel to the health care delivery sector, which is one of the engines of the Massachusetts economy. Furthermore, incentives to purchase software and hardware will draw dollars from other parts of the country because Massachusetts is home to several leading vendors of electronic record products such as eClinicalWorks in Westborough, AthenaHealth in Watertown, and Meditech in Westwood.

In addition to direct stimulus payments to hospitals and providers, our state has already garnered millions of dollars in grants to establish core infrastructure to spur the market. The Massachusetts eHealth Institute, a subsidiary of the quasi-governmental Massachusetts Technology Collaborative, has received almost $25 million to accelerate healthcare information exchange and facilitate electronic health record rollout. Harvard Medical School received $15 million for advanced research in electronic health records. Our academic, government, and industry experts will continue to compete successfully for additional grants as they become available.

On April 29 and 30, Governor Deval Patrick hosted the Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality Conference. HHS Secretary Sebelius, National Healthcare IT Coordinator David Blumenthal, and many governors will attend. It will offer us a remarkable opportunity to showcase the strength of our healthcare technology accomplishments in Massachusetts, and to learn from leaders from other parts of the country.

For all we’ve accomplished, there is much to do.

We still have silos of information locked away in hospitals, offices, pharmacies, and labs. We still have redundant and unnecessary testing because our care is uncoordinated. We’re still using a huge amount of paper in our healthcare facilities. Paper kills.


My grandmother’s life was cut short by medical error. She was prescribed a combination of medications that should never be given to an older person. She developed stomach bleeding, a sudden drop in blood pressure, a stroke, and ultimately died as a result of it.

With electronic health records, data sharing, and decision support rules that inform clinicians about best practices for personalized medical care, she would have avoided harm.

Massachusetts has been an intellectual, economic, and political leader for healthcare IT for decades. We’re now at the tipping point with the funding, momentum, and opportunity to ensure every patient has an electronic health record. The work ahead to complete the transformation of our manual workflows and data silos into a coordinated electronic healthcare system will be hard. Politicians, payers, providers, and patients must work together to make it happen over the next 5 years.

The lives of our grandmothers depend on it.

John Halamka is Chief Information Officer of Beth Israel Deaconess Medical Center and blogs at Life as a Healthcare CIO.

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  • David Harlow

    Massachusetts providers have an added incentive to get wired … it’ll soon be a condition of licensure: EHRs for hospitals and community health centers and familiarity with their use for MDs. See my post on the subject here:

  • Max

    If it will save money, reduce errors, and improve care, it should be GIVEN free to providers. Watch the compliance skyrocket then. Instead you have primary care providers shelling out $25,0000 and $2-5k/yr for these systems. Who wants to do that so I can save the governemnt money? No thanks. Help me save the government money by giving it to me free. Then I’ll help them. But but but it improves quality of care. Yeah, with my back to the patient, figuring out which checkbox I should click, hardly hearing the patient, and figuring out how to upcode by asking that GU ROS I forgot on the URI who walked in the door.

  • Doc99

    If we reject Top Down Solutions, why are we being forced to accept a Top Down Mandate?

  • Paul MD

    Not everyone accepts the premise that it improves care. If it does not improve care by your beancounter parameters, you say it will not be reimburresed. Accepting that it will NOT improve care, it is like being mandated to buy a car that will not run and will not be guaranteed.

  • jsmith

    Please see the post below this one, which states correctly that EHRs mess up doctor-pt communication.
    We’re at the tipping point all right–into the abyss.
    The idea that paper records kill grandmas is absurd. The most recent big study shows virtually no improved care from EHRs. The author’s conclusions are flat wrong. EHRs are an expensive, poorly designed experiment.

  • R Watkins

    Are there any estimates of how many billions of dollars just “meaningful use” requirements will add to our health care costs over the next decade?

    The level of administrative overhead described in this article is unsupportable for small and medium sized practices, and will lead to massive consolidation of providers. As we have seen in Massachusetts, this creates a degree of market domination that allows the big groups to demand payment levels 100% greater than smaller groups. How much money will that save?

  • anonymous NP

    I agree that EMRs don’t always translate to improved care. Recently a pt of mine was admitted to the hospital. The medicine team and hospitalist decded to treat his UTI with cipro.and sent him home within 24 hrs. No one seemed to care that his INR was 2.8 already and would rise on antibiotics, they did not adjust his coumadin dosing or arrange more frequent INR monitoring. Nor were they concerned about potential QT prolongation (he was also on amiodarone). All of these items should have been alerts to the ordering provider as we have a very good EMR. Why were they not addressed? Because the human doing data entry overrode them.
    EMRs don’t fix all the problems and may not have saved your grandmother.
    (ps we met years ago during your 3rd year of EM residency – I was an ICU nurse then…)

  • Marc Gorayeb, MD

    …“broad support from all stakeholders.” “The stimulus bill was crafted very wisely.” “The genius of the program…” “For all we’ve accomplished, there is much to do.” “With electronic health records…. she would have avoided harm.” “The lives of our grandmothers depend on it.”

    There are so many platitudes, so many assertions unsupported by facts, so much bald propaganda, so many contradictions (no “top-down” “solutions” here, please move along), so much transparently sophistic rhetoric in this post, that I don’t know where to begin. I don’t have the time. Forget it.

  • JEngdahlJ

    Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system? More at

  • Adrian Kavanaugh,RN

    The gap between business and clinician has plagued society for eons. The troubles haven’t changed, just the speed at which events happen and the jargon of the day. Will EHR’s benefit business and clinician and patient? Obviously there are strong voices for and against EHR’s. I know it’s an expensive new tool. Patient care errors can and do occur regardless of what tool is used; as the NP indicated, best care choices were overlooked in an (EHR) patient case as they were in your (paper) grandmothers’ case. In both cases, the tools at hand were not utilized for the best outcomes.
    I am becoming a believer in the vast rewards that EHR’s hold the promise of achieving. Ultimately, I hope MA’s leadership in IT utilization can model where the strengths are and where the pitfalls are so that other regions can follow the best and avoid the failures.
    Business, clinician and patient need to learn the new tools, new ways of business, the advantages/pitfalls of near real-time information, and move forward. Change is difficult and change is happening rapidly. We in health care, both as business and as clinicians must find a way to support one another and work more closely together…we need to find the leaders who have successfully bridged the gap between profit and patient, between the good of the organization and the good of the individual in practice and follow their lead. Not easy. Definitely, worth it. I believe there can be WIN, WIN, WIN for us all-business, clinician and patient.

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