May 1, 2007 By Shane Peterson
Health care is serious business.
Spending on health care in the nation reached almost $2 trillion in 2005, or $6,697 per person, according to the most recent research from the U.S. Centers for Medicare and Medicaid Services (CMS).
State and local governments bear a significant portion of the burden, the CMS's research discovered, with the public sector accounting for 45 percent of total health-care spending in the nation.
The spending drains government budgets, and public-sector leaders have devoted much effort to finding solutions to vexing health-care issues. Especially over the last several years, technology has had a profound impact on those solutions, and on health-care delivery and information systems used by physicians, hospitals and hospital systems.
Texas, like many other states, spends a significant amount of money on health care.
Health and human services funding consumed 34 percent of Texas' total state budget for the 2004-2005 biennium, according to Texas Medicaid in Perspective, Sixth Edition, a report released in January 2007 by the Texas Health and Human Services Commission.
Though no state can control every aspect of health-care spending, they can control is the administrative costs associated with health care -- and health IT can help states reduce administrative spending.
The U.S. Department of Health and Human Services broadly defines health IT as technology that allows medical information to be comprehensively managed and securely exchanged between health-care consumers and providers. The cornerstone of health IT is electronic medical records (EMRs) -- a fully electronic medical history for patients that is entirely interoperable within a health enterprise, whether it's a hospital, clinic or private practice.
Over the last couple of years, the federal government has prodded the health-care industry to adopt health IT and EMRs -- but progress has been limited. The world of medicine is slow to migrate to electronic information because medicine is separated into such small economic units, said Dr. Spencer Berthelsen, chairman of the board of directors for Kelsey-Seybold Medical Group, which operates more than 20 neighborhood health centers in the Houston area.
"If you just look at physician practice alone, there are many solo physicians and physicians operating in very small group practices of anywhere from two to 10 physicians," Berthelsen explained. "With so many separate businesses, it's difficult to make a joint decision for everybody to go onto a common electronic medical record."
The cost of upgrading technology to support EMRs in medical practices or hospital systems is another formidable barrier, he continued, especially because of funding limits.
"The funding of health care has been restricted because of the attempts to control the overall cost of health care," he said. "There is very little left over for investment in such things as electronic health records."
On Good Authority
Gov. Rick Perry is one example of a state executive focusing on technology to reshape the health-care environment.
In October 2006, Perry issued an executive order creating the Texas Health Care System Integrity Partnership to advise him on the "finance and governance structure for a public-private collaborative, tentatively named the Texas Health Care System Integrity Authority (THCSIA)."
The order defined the THCSIA's mission as promoting a safe, high-quality, transparent and efficient health-care system in Texas, and charged the authority with: enabling the secure electronic exchange of health information; providing consumers with access to information on the price and quality of health-care goods and services, and health insurance products; and fostering a robust and competitive small-employer health insurance market.
Prognosis for Progress
Perry's 15-member health-care partnership included various stakeholders, such as physicians, insurers, and health plan and hospital systems specialists.
This Digital Communities white paper highlights discussions with IT officials in four counties that have adopted shared services models. Our aim was to learn about the obstacles these governments have faced when it comes to shared services and what it takes to overcome those roadblocks. We also spoke with several members of the IT industry who have thought long and hard about these issues. The paper offers some best practices for shared government-to-government services, but also points out challenges that government and industry still must overcome before this model gains widespread adoption.