As founder and CEO of San Francisco-based Health Technology Center (a.k.a. HealthTech) Molly Coye, M.D., MPH, has her finger placed firmly on the pulse of technological adoption and investment in the healthcare industry. Coye founded the non-profit research and education organization back in 2000 to "develop objective technology forecasts, innovative decision-making tools and facilitate a learning network of experts and health system leaders" for more than 45 of its partner organizations that include healthcare systems, hospitals, safety-net providers and government organizations.

Perhaps her most noteworthy accomplishment of late was plucking David Brailer, M.D., Ph.D., from the private sector in 2003, only to let him go within a year when President Bush tapped him to lead his proposed national healthcare information technology initiative.

Before launching HealthTech, Coye had a varied career, including stints with venture capital firms, consulting and development firms in health technology and communications. She previously directed product development and marketing for HealthDesk Corp., a developer of consumer software for interactive health communication and disease management, and served as executive vice president for managed care at Good Samaritan Health System (San Jose, CA). She served as the director of the California Department of Health Services, and also led the Division of Public Health at the Johns Hopkins School of Hygiene and Public Health and served as Commissioner of Health for the State of New Jersey.

Coye spoke with Healthcare Purchasing News Senior Editor Rick Dana Barlow in late March about the White House’s national healthcare IT effort under Brailer, whether he’s really making a difference and how the initiative ties into supply chain management.

COYE: First of all, I think that Dr. Brailer has made tremendous progress in convincing the world that this is a change that both is needed and is inevitable. He has managed to convey the strength of the evidence that having an [electronic medical record] improves safety and quality, as well as efficiency, and that physicians and hospitals that use EMRs actually wind up being quite delighted with them. So he’s definitely made great progress in convincing people that this is something that is coming and something we need.

In terms of progress among hospitals and outpatient care facilities adopting EMRs, I think that if you follow behavioral change they are on the road. Up until now, even hospitals that saw the advantages or the reasons to invest in EMRs hesitated to do it because of the lack of standardization and the fact that so many other institutions weren’t doing it. So I think that an increasing proportion of hospitals are now developing real concrete plans to enter into investing in EMRs. But in many cases they are waiting to see if the standards are coming forward and exactly what that means in terms of selecting products.

No, it’s impossible even to give a ballpark figure because it’s not only affected by the size of facility but how complicated and different their legacy systems are and a lot of other factors.

I disagree. I think that David has launched some very important steps that will come to fruition this year and next: The continuing rapid development of standards for EMRs, a certification process so that hospitals and physicians can know that an EMR uses those standards and will be interoperable, a process that will develop the [National Health Information Network] so that the infrastructure will exist for healthcare data exchange, and recommendations for ‘pay for performance’ and ‘pay for use’ that will provide incentives and partial financing for investments in IT and EMRs. In addition, I believe that he will define the ‘Regional Healthcare Information Organizations’ (RHIOs) this spring or summer as entities that will finally allow hospitals, health plans and others to pool funds within regions in order to support increased investment in IT. These steps address the most important barriers that a federal office like his could tackle: The need for standards, certification, interoperability and data exchange and incentives. There are many other complex barriers, of course, but we can’t expect even very thoughtful and compelling federal leaders to be able to solve everything for us!

Dr. Brailer has been very frank about the administration’s position that if real progress isn’t made within the next couple of years on these issues that legislation and regulation will be the next step. It would also be the final step in the sense that it would probably be enough to move the world. But they are reluctant to do that. They’d rather not.

Some of the steps that are being taken now, like establishing standards and certifying EMRs, are necessary but not sufficient. I think that the sufficient step doesn’t necessarily need to be requiring specifically the acquisition of EMRs. The same purpose can be accomplished by pay-for-performance approaches that require electronic reporting. Without actually requiring a hospital system to acquire an EMR the fact that they have to report quality and safety statistics electronically means that essentially they have to have an EMR.

Once you have real-time access to information about patients before they arrive at the hospital and in the early stages of their time in the hospital and as their condition changes there will be a whole series of critical information bits that will be useful for managing the supply chain for not only restocking but also for getting the right equipment or goods to the bedside or to the provider at the right point. You can anticipate needs because of access to that information.

In most emergency situations in healthcare the biggest problem is communication because everything is a flail and nobody knows who’s on first or what’s going on except for the physician right at the scene of the disaster or the problem. The ability to have communication systems that can quickly aggregate information – they’ve got 10 different patients affected by a similar thing – you now can figure out what the demand for blood is going to be, what the demand for certain types of surgical instruments is going to be, etc.

The continuing priorities will be to identify barriers in the market and removing those barriers. The first barrier was the lack of standards. They’ve obviously been making great headway on that. The next barrier was confusion about what vendors actually had products that could meet the standards. The whole certification process stems from that. The third barrier was the lack of national backbone on which interoperable information could be exchanged. The issuing of the RFI and the process they’re going through now hopefully will lead to the establishment of a national health information network, which would be the backbone for the exchange of data.

In the future, I think it’s very likely, both from Dr. Brailer’s comments and from what MedPAC has done and a number of other important players in this arena, that CMS reimbursement will begin to move to not only pay-for-performance but quite possibly to pay-for-use of health IT. That was actually a positive recommendation voted for by MedPAC, which sends the recommendation to Congress for Medicare reimbursement. They specifically recommended in January of this year that Congress approve a CMS pay-for-use; meaning, reimbursing hospitals and physicians differentially for their use of health IT. They see the need to do that in order to both provide some of the economic resources that will be needed by providers in order to make this investment and also to provide the incentive to prompt them to move forward with it.

Yes. We already have experiments in that direction like "Bridges to Excellence," which is a major employer-sponsored initiative to reward physicians. I think that’s a good signal that the private sector will continue to go in that direction.

For very broad policy purposes the differences are not terribly critical. But, in fact, it’s very important on a more detailed level that the electronic record includes information more generally about health on a population basis and not just the medical encounter. That’s because you want to know, for example, how on a population basis you’re doing in controlling diabetes and preventing hypertension.

Yes.

For more information about HealthTech, visit their Web site at www.healthtech.org. HPN