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What Can US Learn From European Health IT Experience?

Mainly because of the HITECH Act, part of the economic stimulus legislation passed earlier this year, the U.S. is now finally heading down the road toward widespread health IT adoption and a national health information network. But the discussion about this strategy often gets bogged down in such details as what constitutes "meaningful use" of EHRs.

A longer-term view is provided by a new report from the global consultancy firm CSC. This report compares the health IT adoption effort in the U.S. to the experiences of the U.K., Denmark, and the Netherlands. Overall, the report says, the U.S. is doing all the right things to replicate the best practices gleaned from the European experience.

"If you look at the progress that the U.S. is making with the HITECH Act and with the Office of the National Coordinator of Health IT getting real money, we're doing the right things," says Fran Turisco, a coauthor of the report and research principal, emerging practices, for CSC. "But there are still many tough decisions we haven't faced yet. We're moving in the right direction, and we can look at what other countries have done."

The report argues that, by setting clear expectations, involving all stakeholders, using the "meaningful use" definition to measure value, identifying high-level health IT objectives, and providing financial incentives for the meaningful use of EHRs, the U.S. is showing that it has learned from the European experience. But the big question is whether this country can actually follow in the footsteps of other nations that are further along in this process.

The U.K., Denmark, and the Netherlands all have either government-run or government-managed health systems, and their governments have footed most of the bills for the adoption of health IT and the creation of health information exchanges. The U.S., by contrast, has a mixed public/private system that is highly decentralized. And even the $19 billion allocated for health IT adoption in the HITECH Act only scratches the surface of the enormous investment required.

There is no doubt that centralization of decision-making is a major ingredient of success in computerizing national healthcare industries. This is especially true for EHR certification and interoperability standards. All three of the European countries surveyed established standards at the national level. The biggest challenge to the U.K.'s Connecting For Health program, notably, arose when the National Health Service allowed individual regions to determine which types of EHRs would be available to physicians and whether or not the government would replace their computer systems.

The three countries also use universal patient identification numbers in health care. This is much easier to do in Europe than it is in the U.S., where the mistrust of government is so high that the issue of having a single patient identifier number is no longer even under discussion.

There's also the small matter of our low EHR adoption rate, which is less than 20 percent for physicians and lower for hospitals. By contrast, most physicians in the three European countries are using some kind of EHR.

Despite all of these obstacles, Turisco feels optimistic that the U.S. health IT campaign will succeed in the long run. She points to the creation of the Health IT Policy Committee and the Health IT Standards Committee--both advisory bodies to the Department of Health and Human Services--as evidence that the government is finally recognizing that centralized government policies are essential to adoption of health IT. But I wonder whether those policies will have the intended effect unless the healthcare system itself becomes better organized and less fragmented.