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Bush Executive Order Unlikely To Pump Much Life Into Health IT

Though it pushes federal agencies to use standards-based IT, it won't drive many reluctant doctors to adopt such software.
In the latest U.S. government move aimed at pushing the nationwide adoption of health IT, President Bush Tuesday signed an executive order requiring federal agencies that sponsor or administer health programs, including the U.S. Department of Health and Human Services, to adopt and use interoperable, standards-based health IT systems such as electronic medical records.

In addition to HHS, other large federal agencies that sponsor or administer health programs include the Department of Defense, Veterans Affairs, and the Office of Personnel Management.

The order, which becomes effective Jan. 1, also requires that parties that contract with those federal agencies—such as private health plans that participate in Medicare programs—also adopt standards-based, interoperable systems as they upgrade or implement health IT.

Bush two years ago set out the goal for most Americans to have electronic health records by 2014. Yet progress has been slow, and these orders won't necessarily affect the private-practice doctors who have been most reluctant to adopt electronic-medical records. Some federal agencies, such as the VA, have in fact been aggressive adopters of health IT.

"These orders won't have much effect at all," predicts Stephen Davidson, professor of health-care management and management policy of Boston University's School of Management.

Specifically, the order says that "as each agency implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards."

In addition to those requirements, the executive order also requires that the agencies provide enrollees and beneficiaries of federal health-care programs with "transparency" regarding costs and quality of health-care services. Specifically, the public should have access to cost and quality information regarding the common health services the agencies pay for.

The last health-IT related executive order signed by Bush was in April 2004, when he ordered the creation of a federal health IT czar—the position of national health information technology coordinator. That position was held for two years by Dr. David Brailer, who resigned in the spring. A replacement hasn't been named yet.

The new executive order adds another level of formality in the push for IT adoption to reduce costs and improve quality of care. In addition to the various moves by the White House, a number of health-IT related bills have been introduced in the Senate and House of Representatives over the last year or so, including a health IT bill approved last month by the House.

Many doctors are unconvinced that they should buy costly systems that require many process changes, when the financial benefits from processing efficiency and even improved care don't flow to them.

"The missing link is that not many doctors have systems that talk to each other," says Davidson of Boston University, "and even if the software works in the way it's supposed to work, the benefits of those systems go to the payers and the patients."