Many involved in health IT -- physicians, hospital administrators, industry leaders, legislators and policymakers -- believe rapid, comprehensive movement toward digital health care in this country must be aligned with a major overhaul of the entire health system.
With a new administration in the White House, a Democrat-dominated Congress and a big spending package full of programs to stimulate health IT, it's been full-speed ahead for several months on both fronts -- reform and health IT.
But there is considerable talk in recent days about health reform losing steam in Congress. It's pretty clear there won't be a bill before the August recess, and some say major reform of any kind is unlikely this year.
If Congress fails to pass reform legislation this year, what will happen to health IT? And what, specifically, will it mean for American Recovery and Reinvestment Act funds designated for health IT expansion?
IT Transformation Will Happen, Sooner or Later
Elizabeth McGlynn, associate director of RAND Health, takes the long-term view.
"I start with the belief that health reform -- the transformation from the system we have today to something that is both more effective and efficient -- is a long-term endeavor. Given the history of policymaking in this country, it will likely take multiple steps to achieve true transformation," McGlynn said.
No matter what happens with health reform efforts this year, the country's health system needs to move into the digital age, McGlynn said.
"I believe that developing an infrastructure for a 21st-century health care system is absolutely essential. Many of the ideas people have for changing the health care system frankly will be difficult to implement in the absence of an appropriate infrastructure -- and IT is a critical part of that design," McGlynn said.
David Merritt, vice president and national policy director at the Center for Health Transformation, said that a major reform package could help speed up health IT's movement toward the mainstream.
"Health reform could definitely help, but its absence won't change our course nor would it wipe out any progress we've already made," Merritt said.
Changes 'Easier' in Broad Reform Context
Merritt -- whose organization established by former Speaker of the House Newt Gingrich (R-Ga.) is not necessarily a proponent of Democratic reform plans -- said change on a national scope, no matter which party orchestrates it, would make health IT evolution a smoother process.
"If there is a broader reform package, it would be easier to encourage providers to also make the changes necessary to move into the digital age. It would be one of many changes they'd have to accept," Merritt said.
Merritt said the longer Congress goes without passing a reform bill the harder it will get.
"We've seen it go over the past several months from pretty much a certainty that something would get through to now a whole lot of doubt," Merritt said. "As you move from the broad concepts and philosophical arguments into real legislation, you begin to see details that will divide the industry. And we're right in the middle of that as we speak," he added.
"If it doesn't happen in the next six months, it might not happen at all," Merritt said, adding, "Moving it into 2010 may be logistically impossible. It will be midterm elections, and people will have other things on their minds."
Merritt said, "The calendar really starts being an enemy of the process around Thanksgiving time. If things aren't wrapped up by then, I don't know if they ever will be."
Health IT on Course, Regardless
Both Merritt and McGlynn believe the federal stimulus package has the country aimed in the right direction, regardless of what happens with larger reform efforts.
"The ARRA funds provide an initial impetus to stimulate wider adoption of HIT and to begin creating a business case for that adoption. I believe this work can go forward whether or not a bill passes this year," said McGlynn, who manages COMPARE (Comprehensive Assessment of Reform Efforts), RAND's online analysis of national health care reform proposals.
Many of the country's initial health IT programs are under way in small pilot projects and most can move forward whether a broad reform package passes this year or not, McGlynn said. Letting digital health care spread a little more before larger reform happens could be advantageous, McGlynn suggested.
"In many ways, giving IT a head start will be necessary in order for it to be up and running and available for use in changing the way we pay for and deliver health care services," McGlynn said.
Organizations Call for Change in Concert
Earlier this month, three organizations -- the Markle Foundation, the Center for American Progress and the Engelberg Center for Health Care Reform at the Brookings Institution -- issued a joint statement saying improvements in health and reductions in costs are achievable if efforts to boost health IT are aligned with broader health care reform.
"Health reform and health IT investments will protect all Americans only if we set concrete health improvement targets and identify the specific costs to be controlled," Markle President Zoe Baird said in a statement. "We know how to prevent one million heart attacks and strokes and how to slash the time physicians spend on administrative tasks. Let's set these goals and others like them. This is the only way we can expand coverage, improve outcomes and control costs."
Echoing the three organizations' call for concerted effort, McGlynn said economic and social pressures will lead to reform and the spread of health IT.
"I think the pressure for developing more effective ways of managing health care will continue to build from consumers, from payers and from providers," McGlynn said.