In July 2004, the U.S. Department of Health and Human Services (HHS) announced a landmark, 10-year plan to build a Nationwide Health Information Network (NHIN) to link health records nationwide. The plan's success, however, depends on eliminating paper medical files and creating an electronic health record (EHR) for every American.

Developing EHRs -- which, like traditional patient files, would contain detailed information about an individual's medical care and health history -- is a high-visibility issue for the HHS because of skyrocketing health-care costs and the dramatic impact they have on public-sector budgets.

Studies over the past several years point to health IT as a tool for improving quality of care, reducing errors and delivering significant cost savings, according to the HHS, and the potential value of the interoperable exchange of health information among disparate entities is substantial.

National implementation of fully standardized interoperability of health information between providers and other health-care organizations could save $77.8 billion annually -- approximately 5 percent of the projected $1.7 trillion spent on health care in the United States in 2003 -- according to the HHS Office of the National Coordinator for Health Information Technology (ONCHIT).

Other studies estimate that 20 percent to 30 percent of healthcare spending in the United States -- up to $300 billion each year -- goes to treatments that don't improve health status, are redundant, or are not appropriate for the patient's condition, said ONCHIT.

It's clear that EHRs and a national health IT strategy can play a huge role in streamlining the delivery of health care to patients across the country.

Roughly two years later, however, widespread adoption of EHRs is far from smooth. Making the transition is clearly a difficult process, but regional efforts within states appear to be accomplishing the most.

Texas and Massachusetts are strong advocates for EHRs, and have begun implementation in various health care facilities. The role of state government in this transition, however, remains unclear.

Next-Generation Records

Though the push toward a NHIN is decidedly top down, prodding physicians, hospitals and health systems to adopt EHRs is necessarily grass-roots.

The best person to persuade a roomful of skeptical doctors of EHRs' efficiency gains and enhanced access to health information is another physician. It's similar to the spread of e-government: State and local governments look to see the root of a particular trend, then talk to the officials from that jurisdiction to pick their brains.

"I think this is probably what President Eisenhower faced when trying to grow an interstate highway system that all of us can use and travel on," said Pat Wise, vice president for Healthcare Information Systems at the Healthcare Information and Management Systems Society (HIMSS).

Designing a highway system capable of carrying all sorts of traffic -- local, regional and national -- requires significant advance planning, Wise said, and EHR adoption is no different.

"You have to map out, in some fashion, how these documents should travel," she said. "And clearly, not only do some people want to travel from the East side of the nation to the West and from the North to the South, but the larger number of people just want to travel in and around the city themselves. They don't even want to go to another state."

This is because most health-care referral patterns are local, Wise explained, and physicians, hospitals and health systems in cities have begun building health information exchanges (HIEs), often funded by federal grant money. According to the HIMSS's latest data, approximately 137 HIEs dot the country, and more crop up every month.

The push behind the HIEs' creation is to improve and simplify health care. HIEs serve as the mechanism for physicians, hospitals and health systems to exchange patient information electronically -- information that, so far, hasn't

Shane Peterson  |  Associate Editor