With all the talk about the politics of health reform, it's easy to forget that a major driver of the landmark legislation will be the expanded use of health IT. The award in early April of four $15 million contracts seeking health IT research "breakthroughs" was a timely reminder of its importance.
The Office of the National Coordinator (ONC) promoted the Strategic Health IT Advanced Research Projects (SHARP) awards"to Mayo College of Medicine, Harvard University, the University of Texas Health Science Center at Houston and the University of Illinois at Champaign-Urbana"as a way of meeting future, more ambitious applications of health IT.
"The very ambitiousness [of these future applications] requires an improved level of technology to support it," said Dr. Charles Friedman, the ONC's chief science officer. "And we believe we have a significant role to play in catalyzing the improvement of that technology."
The awards are aimed at technology developments in four areas the ONC has deemed most important in supporting meaningful use: health IT security, which the University of Illinois will tackle; patient-centered cognitive support of physicians (Texas); innovative application and network-platform architectures (Harvard); and secondary use of EHR data (Mayo).
There's no apparent disagreement from the industry and health IT professionals about ONC's focus on these four areas as the most important to pursue, though there is debate over the relative impact of one vs. another, or the specific technology advances that would mark true breakthroughs.
Security for health IT data both at rest and in transit from one physician site to another is universally seen as a potential deal-breaker, for example. If security can't be guaranteed, then it's unlikely that patients will use electronic health records with any enthusiasm.
Buried knowledge
However, some believe it's equally important to ensure that EHRs deliver much better performance and value than they do now. Large institutions are starting to implement EHRs, but the adoption rate by smaller physician practices is very low because they don't see a business case for them.
It's for that reason, for example, that Dr. Blackford Middleton, director for clinical informatics research and development and chairman of the Center for Information Technology Leadership at the Partners HealthCare System in Boston, considers cognitive support and platform architectures as the two most important SHARP areas.
Cognitive support aims to help physicians really understand what information is in an EHR, and how they can get that data out so they can really know what kind of treatment is needed for a particular patient. They can currently get to just over half of that data, he said, "but (getting to) the rest is a crapshoot."
Likewise, it's vital to make EHRs easier to work with. The companies that develop the software for those records build everything according to their own specifications. Everything is proprietary and little thought is given to such things as modularity that will make it easier to match EHRs to specific users' needs and introduce new functionality.
"That's not where the rest of the software industry is going, with such things as mash-ups and so on," Middleton said.
iPhone Usability
In that case, the first indications from the SMART program show some promise. One of the first proposals that Harvard will be working on is an iPhonelike platform for EHRs that will allow for application modules to swap in and out of the EHR, in much the same way that iPhone users can download or discard iPhone apps.
That would be a breakthrough, Friedman said, because it will allow developers to focus on highly innovative approaches to things like user interfaces for EHRs, which in turn will push rapid improvements in their performance.
It may take a while before the full impact of the awards are clear. The ONC hasn't yet done the kind of analysis of the projects to distil out of them exactly what it is they are trying to do, Friedman said. That might become clearer as part of separate evaluation contracts, which the ONC expects to award soon.
Mindful of the short deadlines for the start of meaningful use, the ONC is trying to wring as much as it can and as quickly as it can from SHARP. The Office believes current health IT is adequate to meet the definition of meaningful use for 2011, but that subsequent versions will need the kind of breakthroughs that the SHARP programs envision.
Each of the programs will deliver solutions that can be inserted into products within two years, while also exploring more fundamental problems over the full four-year term of the contracts, the results of which will appear in peer-reviewed journals and other outlets.
The ONC also expects that the relationships formed around the tech transfer in the two-year window will follow through to the four-year programs, with possible products resulting from that.
If there's any downside to SHARP it's the lack of clarity about what will or won't come after these first contracts run their course. The $60 million for SHARP came out of ARRA funds and there are no plans for a successor, Friedman said.
