As Medicaid absorbs the lion's share of state budgets and federal agencies move to standardize IT systems, health care and IT become closer bedfellows. In August 2006, President George W. Bush issued an executive order to federal health agencies regarding technology: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs. In the order, Bush mandated that "health-care programs administered or sponsored by the federal government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health-care quality and price, and better incentives for program beneficiaries, enrollees and providers."

Bush ordered agencies to accomplish these IT health-care objectives in collaboration with the private sector and the nonfederal public sector, and without additional cost to the federal government. Affected agencies include:

  • Medicare;

  • Federal Employees Health Benefit Program;

  • Indian Health Service;

  • TRICARE of the Department of Defense; and

  • Department of Veterans Affairs health-care program.

    Federally funded state-operated programs such as Medicaid, the State Children's Health Insurance Program or services provided to Department of Veterans Affairs beneficiaries are not part of this presidential mandate. However, the spirit of these requirements is bound to trickle down to the states as they set the tone for contracts between federal agencies and the private and public sectors. And like it or not, all state bureaucracies funnel federal funds, and often take cues from federal agencies in forming public policies and structuring their own agencies.

    The "interoperability" buzzword plays a large part in the order, in which it is defined as "the ability to communicate and exchange data accurately, effectively, securely and consistently with different information technology systems, software applications and networks in various settings."

    Now that fusion of information systems is a presidential mandate, there is no turning back to the age of silos, even in the federal government. Hopefully patients nationwide will benefit from this focus on efficiency. The order can be viewed online.

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    Cities and counties nationwide continue to search for IT solutions to health-care problems. The Public Technology Institute (PTI), a national city and county executive-level organization based in Washington, D.C., launched its Task Force on Health-Care Technology for Cities and Counties to serve as a resource for local government officials responsible for implementing IT solutions to manage health-care services. According to a press release, PTI created the task force to address "a growing crisis in providing health-care services to residents, particularly when it comes to using technology to better manage those services." Among the challenges facing local governments are complying with Health Insurance Portability and Accountability Act requirements; storing and sharing sensitive records; creating appropriate system architectures; and strengthening IT security.

    The task force is inviting participation from local officials, and will then formulate a research agenda to tackle these issues. County and city governments can expect to see the group publish white papers and articles that recommend solutions for improving health-care delivery with IT applications and management practices. For more information on the task force, visit www.pti.org.