The healthcare IT industry just marked  the 10-year anniversary of then President George W. Bush’s call to action – in his 2004 State of the Union address – to finally transform a paper-mired healthcare system into a digital-age industry that operates more like other sectors of the economy.

As we look back on 10 years, we spoke to some leaders on the frontline of health information technology, asking them to take measure of how far the industry has moved towards a truly high-tech, data-driven system of care.

Bill Spooner, Sharp Healthcare
Bill Spooner, vice president and chief information officer of Sharp Healthcare in San Diego has had an epiphany or two on his way to digital transformation. There was a time, for instance, when he advocated for best-of-breed systems. But he changed his tune when he realized there were too many interoperability headaches.

In an interview with Healthcare IT News in early 2010, Spooner addressed the issue of best-of breed technology versus enterprise systems.

He was proud, he said, of his and his colleagues’ willingness to make a change when it became clear they needed to go in a different direction on their core hospital systems, or EMR, back in 2006.

“We were willing to recognize that the strategy we were taking in terms of our best-of-breed group of products just wasn’t going to bring us the value that we really needed to achieve,” Spooner said in the interview. “We began to pull out a half a dozen best-of-breed products in exchange for the integrated group of products that we are now implementing from Cerner.”

Spooner may have been early to change his tack, but today he is far from alone, with many medium and large health systems rolling out Epic or Cerner EHRs. Even pioneers in health IT are replacing their homegrown systems with commercial systems, usually with either Epic or Cerner, the two most selected enterprise EHR companies in the market today.

Partners HealthCare in Boston is in the midst of an Epic system rollout. Intermountain Healthcare in Salt Lake City recently announced a partnership with Cerner.

"We have very set ideas on how we think these systems should work, and we feel very passionately about it," said Intermountain CIO Marc Probst, in a video announcement last September. "Intermountain is committed to being innovative in the area of information systems."

Intermountain is recognized as one of the pioneers of innovation, having built its own systems from the get go to advance its data-driven approach to healthcare, which continues today.

Cerner’s open architecture technology was critical to Intermountain’s decision to partner with the EHR vendor, Probst said. Among other advantages, the open architecture will allow for the addition of the new Intermountain content. Cerner’s focus on population health was another attraction.

"We share a common vision to improve care for populations of people," said Brent James, MD, chief quality officer at Intermountain.

"This partnership will accelerate our efforts to provide core functionality to our caregivers as we create new innovations to transform healthcare,” he added, in a video announcing the launch. “By integrating the Cerner system with our electronic data warehouse, we will continue to drive improvements in healthcare quality."

At Partners HealthCare, Scott MacLean, deputy CIO and director of IS Operations, said: “We realized that much of the functionality we developed is available commercially, so we're adopting a vendor platform and will focus our innovation on genomics and other research discoveries we want to bring to the bedside and clinics.”

Sharp Healthcare’s Spooner said that today the health network has very little paper comprising the patient record. Physicians enter orders virtually, and they document online.

“The data has become actionable for care improvement,” he said.

In the not so distant past, physicians at Sharp Healthcare were not convinced the EMR was essential to the quality patient care, Spooner said. “Today they see it as indispensable to care. My challenge is to regularly bring added or improved EMR functionality, and to ensure constant availability – no scheduled or unscheduled downtime.”

Paul Tang, MD, Palo Alto Medical Foundation
As vice president and chief innovation and technology officer at the Palo Alto Medical Foundation, as well as a top federal policy adviser, Paul Tang, MD, brings a unique perspective, as does Probst who, like Tang, serves as CIO at Intermountain and also sits on the federal Health IT Policy Committee, which advises the federal government on healthcare IT matters.

The HITECH legislation, and the EHR Incentive Program in particular, was the most significant and impactful HIT federal policy in the past decade, Tang said. It was also a necessary enabler for the Affordable Care Act that followed a year later, he added, since health information technology and EHRs are essential to support the transformation required by health reform.

“It’s clear that providers – both physicians and hospitals – cannot undertake the transition from volume to value without knowing their current performance and its costs and without having an electronic infrastructure to effect continuous improvement,” Tang said. 

Tang is optimistic. He noted that in just two years time, the number of providers who have achieved meaningful use soared from about 3 percent, pre-HITECH, to more than 60 percent of eligible providers in 2013. Also, more than 80 percent of hospitals have invested in EHRs, he added.

“Yes, we have more work to do as we climb the meaningful use arc towards health information exchange, care coordination and patient engagement required in Stages 2 and 3,” Tang acknowledged. “But the laying down of an electronic infrastructure for the future is a salient milestone that wouldn’t have been possible without HITECH.”