e-Health and Patient-Centered Care Processes in the United States of America
American health care is the second most expensive in the world as part of GDP and is now facing big changes. In 2010, the Health Care Reform was signed, making health insurance by 2014 available to millions more Americans than today. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed as part of the American Recovery and Reinvestment Act (ARRA) in 2009, and invests large sums of money in modernizing the health care system by promoting and expanding the use of HEALTH IT.
There are a large number of activities initiated by the HITECH act, mainly related to the development and usage of Electronic Health Records (EHRs). To the uninitiated some of the initiatives seem to overlap and in addition, numerous agencies and organisations are involved. The reason for this bottom-up approach instead of a top-down authoritarian approach is presumably the fear by many Americans of socialized medicine and the federal government taking too big of a role regarding health care. This in turn has led to the highly complicated structure of the health care system and the very different levels at which HEALTH IT is currently used in the United States, if at all. The needs are very different and the specific applications now being developed in different parts of the country will most likely differ significantly. The next step will be to connect and make all the HEALTH IT systems interoperable once they are up and running. This approach might seem ineffective when there is so much money invested at one time by the federal government. However, it is quite expected in a country where many want the federal government to be as little involved in their lives as possible. Many believe that the semantic web (2) will be used in order to extract data from the different systems.
All federal guidelines for Health IT in the United States have the patient in focus. The HEALTH IT solutions having been and being in the process of implementation in the country all appear to follow those directions. Clearly, Sweden should follow the progress of the numerous systems now being developed in America, particularly in the development of EHRs. This is an area where Sweden might be more advanced than the United States and there should be possibilities for Swedish companies and other stakeholders to partake in the large investments being made.
The HEALTH IT systems at Kaiser Permanente and the Veterans Health Administration are well developed and applicable to Sweden for many reasons: Their organisations are run more like a “landsting” than any other American health care organisation. They support approximately the same number of persons that live in Sweden; the Veterans Health Administration has patients all over the country and Kaiser Permanente has patients of all ages. It would therefore be of great interest for Sweden to study the HEALTH IT solutions in these two organizations in more detail.
Many activities on the state level are in progress in the United States. Swedish stakeholders should follow the development of the HEALTH IT systems in several different states, for example Rhode Island and Indiana.
It could be of interest to Sweden, where nurses traditionally have a strong position, that the role of nurses, their responsibilities and education are predicted to change significantly as a consequence of the increased need for care that the health care reform will bring. One could expect that there will be a shortage of nurses in the United States due to these changes. A future shortage of HEALTH IT professionals is anticipated in the United States due to the planned increase in HEALTH IT usage. The present drive by universities and colleges to support training and development of such professionals is in response to that scenario. Could HEALTH IT professionals and nurses become a Swedish export? Feasibility studies could be done in this area.
Swedish companies should be informed of the many possibilities of medical innovation in the United States, not only in HEALTH IT in general, but in e-prescription, data mining and analysis, care integration tools and decision support, specifically. The high level of funding currently being invested into HEALTH IT in the United States opens up many possibilities for a variety of stakeholders, including Swedish.
(2) The Semantic Web is a "web of data" that enables machines to understand the semantics, or meaning, of information on the World Wide Web, according to Wikipedia: http://en.wikipedia.org/wiki/Semantic_Web