Dr. Kevin Fickenscher, executive vice president of clinical transformation for Perot Systems, has witnessed progress in how healthcare organizations plan their technology investments and implement new systems. For example, rather than putting CIOs in charge of purchasing and implementing clinical information systems (which house the electronic medical records), more organizations are putting chief medical officers in charge of EMR deployment. “Today, more organizations recognize that these are not IT projects,” he explains. “They are clinical projects, and if you don’t address core clinical issues, your ability to drive value just isn’t there.”

The interoperability of EMR applications remains the largest technical hurdle, and one that the federal government seems interested in helping healthcare companies and their service partners address. In 2004, President Bush unveiled a 10-year effort to drive EMR adoption with $100 million in seed capital. Last year, the U.S. Department of Health and Human Services (HHS) awarded $18.6 million of that money to four projects — three of which are led by CSC, Accenture, and IBM, respectively — designed to develop prototypes for a Nationwide Health Information Network (NHIN) architecture. The purpose is to develop interoperability standards so that digital health records can be shared among different healthcare providers in a secure, effective, and efficient manner.

In the private sector, some organizations are putting EMR through its paces on their own. Massachusetts Blue Cross Blue Shield allocated some $50 million to launch a collaborative e-healthcare effort. And IBM has launched an EMR program for its own employees.

Those initiatives and similar ones reflect what Fickenscher describes as a “sea change in attitude” among consumers, providers, and insurance companies, many of whom are increasingly “demanding that quality and patient safety be a priority of care that is provided.” That desire is pushing healthcare toward a “pay for performance” model; rather than getting paid based on volume, healthcare providers would get paid based on the degree to which their care meets certain quality standards. To work, that sort of shift (which would be incremental) requires accurate information. “There is no way for clinicians to respond to an outcomes-based reimbursement model if they don’t have an adequate clinical information system in place,” Fickenscher asserts.

To an outsider, electronic medical records (EMR) projects might sound like a global enterprise resource planning (ERP) implementation combined with a massive transformation project. Health-care consultants involved in EMR projects prefer other analogies. The travel industry’s move to ticketless travel and financial services’ current development of health savings account offerings are commonly cited comparisons. Ivo Nelson, healthcare industry leader, global and Americas, for IBM Business Consulting Services (BCS), prefers to compare the move to EMR to the emergence of automated teller machines, which required banks to figure out a common way of getting their machines to talk to one another. That interoperability challenge is what the U.S. Department of Health and Human Services (HHS) is hoping to work through by funding projects, to the tune of $18.6 million, designed to develop prototypes for a Nationwide Health Information Network (NHIN) architecture. A quick look at the parties involved in the three regional health market projects spearheaded by IBM, CSC, and Accenture illustrates the complexity involved in digitizing healthcare records: CSC is partnering with 11 different technology and service firms to develop standards that govern the sharing of electronic health records in three regions. The projects are complex, long (up to eight years in some cases), expensive (measured by hundreds of millions of dollars for large healthcare and hospital systems) — and valuable. Nel-son estimates that one phase of an EMR initiative at the University of Pittsburgh Medical Center (UPMC), which IBM is currently partnering with on an eight-year, $402 million joint development agreement involving EMR and technology infrastructure, will help the organization bank some $100 million in savings over a five-year period.