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Executive Summary

Emerging technologies offer an unprecedented ability to provide accurate and actionable medical information in a secure and private form when and where it is needed, whether by patients themselves or by the clinicians who care for them.

When Connecting for Health ... "A Public-Private Collaborative" was launched by the Markle Foundation in June of 2002, its mission - identifying and removing barriers to the growth of electronic connectivity in healthcare - and its methodology - a broad-based coalition - were anomalies. Today, they have become the accepted wisdom. There is now widespread recognition that the economic and clinical inadequacy of a paper-based health information system is a serious problem. The need for "interoperability" in healthcare information technology (IT) has gone from an item on the private wish list of IT insiders to a public priority of the President of the United States. The Department of Health and Human Services has appointed a National Health Information Technology Coordinator to work with government and industry, and members of Congress have even connected across party lines to address the need for information technology to help transform the healthcare system.

While general acceptance of one's aspirations is certainly an accomplishment, a swelling of the ranks of those championing change cannot substitute for a concrete and deliberate implementation plan. This Preliminary Roadmap lays out a series of recommendations for practical strategies and specific actions to be taken over the next one to three years that will bring us measurably closer to solutions. This roadmap - like most - helps the traveler to choose directions and to take turns. Although we do not know which of the emerging innovations in U.S. healthcare will be most successful, we do know that most of them cannot be realized without the rapid, accurate, and secure exchange of personal health information among authorized users. And we believe that the greatest improvements in healthcare - leading to the most profound opportunities for better health - will occur when each American can access, control, and make use of their own health information in partnership with their care team.

Our recommendations are designed to be practical. We are proposing manageable actions to be taken over the realistic time frame of the next one to three years. It is not possible or even desirable to dramatically transform the healthcare system through a sudden "big bang," whether brought about by public or private efforts. We believe that the existing system needs to be improved and built upon, and that the effect of carefully planned incremental steps can be equally transformational and more likely to succeed over the long run. Our realistic recommendations are not intended to discourage bolder actions now or in the future, but they allow a large proportion of stakeholders to make measurable progress now. In fact, because of their strategic nature, they set the stage for bolder actions to follow.

The task of realizing electronic connectivity in healthcare will require a variety of stakeholders to take a range of different actions, some of which must be closely coordinated, while others may occur separately but in parallel. Our recommendations fall into three broad categories: Creating a Technical Framework for Connectivity, Addressing Financial Barriers, and Engaging the American Public. The three are, of course, closely intertwined; individual stakeholders may be required to take action in one, two, or all three areas.

The practicality of our recommendations may be most immediately apparent in the technical and financial areas. On the technical side, we recommend accelerating electronic connectivity by building on existing infrastructure to create a "network of networks," which is based on standards, decentralized, and federated to support broad use by clinicians and patients while safeguarding patient privacy. On the financial side, we recommend the realignment and, in some cases, creation of both financial and other incentives that are designed to promote the use of standards-based electronic health records and electronic connectivity. As part of this work, we investigated the question of what minimum level of financial incentives would be necessary to cause "tilt" or catalyze systemic change. We focused especially on small and medium sized ambulatory practices at this juncture, and found that the amount of investment is more manageable than many people had imagined.

Despite the powerful and even lofty ring of our recommendations to engage the American public, which involve educating and empowering patients, these may in fact be the most pragmatic recommendations of all. The current healthcare system is in dire need of improvement and modernization. Society cannot afford to infuse it with more money, and providers are already stretched to their capacity. The aging of the baby-boomers promises to stress the system even more. While the increased and smarter use of information technology is essential in addressing these problems, its impact will be greatly magnified by a higher level of patient involvement. How can we afford not to harness the underutilized power of patients to help advocate for and contribute to a system that can better serve them? No one has a greater level of investment in healthcare than the individuals who live or die based on its quality.

- "Achieving Electronic Connectivity in Healthcare: A Preliminary Roadmap from the Nation's Public and Private-Sector Healthcare Leaders," Executive Summary by Connecting for Health http://www.connectingforhealth.org, The Markle Foundation http://www.royblakeley.name/larry_blakeley/philanthropy/markle_foundation.htm and The Robert Wood Johnson Foundation http://www.royblakeley.name/larry_blakeley/philanthropy/robert_wood_foundation.htm, July 2004 http://www.connectingforhealth.org/resources/aech_exec_summary.pdf