A Discussion with National Health Information Technology Coordinator David Blumenthal
April 22, 2010
“We have to start seeing health information systems as a mainstream technology that is part and parcel of medical practice, not something that is appended to it as an afterthought, not something that’s imposed on it, but something that will very soon be integrated into it and indistinguishable from all the other work that physicians and other health professionals do every day.”
So says David Blumenthal, National Coordinator for Health Information Technology (HIT), in a recent interview in the April issue of Health Affairs devoted to HIT systems. (Health Affairs is a Burness client.) The interview was conducted by Blumenthal’s predecessor, David Brailer – the first HIT czar under former President George W. Bush. As Brailer notes, “David Blumenthal inhabits a different world than I did. But many of the challenges and issues remain the same.” It’s hard to imagine a better pair to discuss HIT implementation, and Brailer-Blumenthal doesn’t disappoint.
The interview delves into the challenges and opportunities of diffusing HIT systems into medical practice. They discuss the constantly shifting definition of “meaningful use” – the standard to which HIT users are held – and what it means for implementation. Striking a balance between a lower standard (that can get reluctant providers engaged in HIT) and a high one that (that can make sure they’re using it well) is a major goal for Blumenthal:
“I commonly refer to this problem as the escalator problem. We have to get providers on the escalator, get them moving up the escalator, keep them on the escalator toward more and more sophisticated and demanding uses of electronic technologies. We don’t want them jumping off, we don’t want them running back down in terror at what we’ve asked of them. But we also don’t want the escalator to turn into one of those airport moving walkways where you end up after a long trip at precisely the same altitude as where you started.”
Another priority for the Office of the National Coordinator is the development of a strong workforce for HIT, which, according to Blumenthal, provides great opportunity for young people. Also essential to his work is developing an effective system that integrates successes around the world in places like France, Denmark, and Germany into a national program. And they discuss the potential for HIT systems to provide data that inform public health and public policy.
Of course, this is all dependent on privacy and security of health information, which Blumenthal calls the “foundation” of effective HIT. “We have to start with guarantees of privacy and security before we can begin to develop these other, more sophisticated uses of aggregated data that depend on extracting patient information in deidentified form from electronic systems in local offices and in local institutions,” he says. Failure to do so, he warns, could damage public support for the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act.
To Blumenthal, though, these concerns are surmountable. And he is convinced that national health reform will greatly accelerate the HIT agenda. The payment reforms and emphasis on accountability in the Patient Protection and Affordable Care Act, Blumenthal says will heighten both providers’ and payers’ attention to measurement and improvement – key tenets of HIT.
“The purpose of health information technology is to support health reform, and it is part of that larger puzzle,” he adds. It is not a stand-alone goal or an end in itself.”
The full interview is available at the Health Affairs website.
The April issue of Health Affairs includes many studies on HIT implementation. Two highlights include:
- A new study by Colene Byrne of the Center for IT Leadership at Partners in Healthcare, Charlestown, Mass., offers a vision of the potential benefits of wise investment in HIT. The authors analyzed the value of the Department of Veterans Affairs’ investment in four VA-wide HIT systems, and estimated that from 1997 to 2007, the investment yielded $3.09 billion in potential cumulative net benefits while improving health care quality. In both HIT adoption and quality, the authors found, the VA leads the private sector, which has not spent as much proportionately on the technology,.
- Interaction with health IT is increasingly becoming a part of the patient experience.. James D. Ralston and his colleagues at the Group Health Cooperative’s Group Health Research Institute in Seattle found that nearly one-third of all Group Health patient encounters with primary care physicians were conducted through secure e-mail messaging. Ten percent of patients reviewed their test results electronically, and 10 percent ordered medication refills online. Fifty-eight percent of Group Health patients accessed their EHRs in 2009, a steady increase since 2002. The authors call for an expanded definition of “meaningful use” that includes measures of patients’ experiences with EHRs, so that the focus of care remains where it belongs: on the patient.
Photo from Health Affairs April issue.
