request appointments online, do secure messaging, self-management, have glucometer and blood pressure machines record and submit data?" Waldren said. "That's how the Web portals start to be of higher importance and greater value."

But the four-year deadline for building an insurance exchange won't be hard to meet in Massachusetts; the commonwealth is three years ahead of the curve. In 2007, as part of the state's own health care overhaul, Massachusetts officials established the Health Connector, an independent public authority, to regulate the state's insurance exchange through a Web-based marketplace.

The project costs about $600,000 a year to run, said Bob Nevins, CIO of the Health Connector. Under Obama's plan, however, the Health Connector will have to make minor changes to its system. For instance, the new law makes more people eligible for subsidized insurance and adds provisions to provide tax credits for small businesses. But overall, Massachusetts stands as the go-to source for states that want to know how to build an insurance exchange Web portal that works.

The Health Connector's Web portal contains pathways for two insurance programs: subsidized, which is managed by the state's Medicaid agency, and unsubsidized, which provides commercial health insurance plans. In the unsubsidized shopping area, customers provide a date of birth and zip code, and the system grabs coverage details and rates from six health carriers. From there, customers can compare programs, enroll online and make an e-payment to begin coverage in the program they choose.

The Health Connector chose to buy the portal, Nevins said, rather than build its own. But, he added, IT staff still had to make contracts with health carriers, figure out hosting and Web strategies, and take into account what matters most to customers shopping for health insurance: premiums, deductibles, doctors available in various plans, etc.

"That's where we really had to apply a lot of creativity and do research, to figure out to how to present a shopping experience in an easy-to-use interface," Nevins said. "If you overload customers with too much information, they just get lost."

3. Adopting electronic health records

With a federal goal for Americans to have electronic health records (EHRs) by 2014, the U.S. government wants to implement an interoperable nationwide network, where health records -- test results from labs and radiology, disease and symptom records, CT scans, etc. -- can be accessed online from anywhere.

The Recovery Act upped the ante for hospitals adopting EHRs, setting aside $19 billion in incentives for systems that meet specific criteria. But, for hospitals, health-care reform's massive expansion of coverage might be incentive enough.

"With 30 million new records to enter, even skeptical physicians may decide that it makes sense to jump on the EHR bandwagon now in order to better manage new patients," said Jon Oltsik, a senior analyst at Enterprise Strategy Group, an integrated, full-service IT analyst and business strategy firm.

The new law, Oltsik added, might also motivate health care firms to form partnerships to extend networks for "more data sharing and IT services over a greater pool of health care providers."

But skeptics say it's way too soon for governments to use EHRs to hedge their bets. A national health-care project in the UK using experimental health IT as a pillar for reform has been disastrous, according to Scot M. Silverstein of Drexel University, a physician and health IT expert.

To support his stance that EHRs have been "overhyped," Silverstein cites numerous studies concerning health IT cost overruns and failed systems. He also points to Jeffrey Shuren, director of FDA's Center for Devices and Radiological Health. At a health IT safety meeting in February, Shuren stated that "in the past two years, we have received 260 reports of HIT-related malfunctions with the potential for patient harm -- including 44 reported injuries and 6 reported deaths." In terms of health IT-related problems, he added, these incidents may represent only the "tip of the iceberg."

"It's mystifying why they think this technology is ready to plug-and-play," Silverstein said. "It really isn't ready for prime time. While health-care reform is a great idea, if you depend on health IT as one of its pillars, you end up with project failure, lack of acceptance, information systems that are impossible to use and you end up killing people."


Russell Nichols  |  Staff Writer