Q&A: Health IT Czar Rethinks National Data Exchange

David Blumenthal talks about making national network accessible to small healthcare providers and also shares thoughts on the Massachusetts election, e-medical records use, and the health IT workforce.

The U.S. government for six years has been developing the Nationwide Health Information Network, a network of regional health information networks to enable the secure sharing of patient data. Now NHIN is being re-envisioned, national coordinator for health IT, Dr. David Blumenthal told InformationWeek.

Instead of aiming to have all healthcare providers on one granddaddy of a national network, the new goal is to get more providers sharing data, even if it's just with practitioners in their immediate vicinity.

Blumenthal discussed the nation's health information exchanges, as well as the Massachusetts election, criteria being developed for the meaningful use of e-medical records, and the health IT workforce in an interview with InformationWeek senior writer Marianne Kolbasuk McGee.

InformationWeek: As a Massachusetts native, what's your reaction to Republican Scott Brown winning Ted Kennedy's Senate seat? Do you expect any impact on healthcare reform and health IT efforts?

Blumenthal: People from both sides of the aisle recognize that health information technology is essential to a modern healthcare system. I expect that our efforts will continue unimpeded by this event. As far as health reform, I'll leave it to the White House to comment on that.

InformationWeek: There's been criticism of the meaningful use rules, which require healthcare providers to demonstrate "meaningful use" of EMRs in order get reimbursed for investing in those systems. The rules are close to being finalized, but have been criticized for having watered-down quality measures, such as those related to patient progress notes. Was it a challenge to develop rules that were achievable for healthcare providers within the timeframe set up in stimulus legislation?

Blumenthal: Congress set very ambitious goals for the HITECH legislation. The concept of meaningful use is novel, and a very powerful and important concept. The process of defining meaningful use has gone through many months, through many public hearings.

We received a great amount of public comment and an enormous amount of [input] from our Health IT Policy Committee and from the community at large. Now the community has a chance to comment again on the proposed rules.

I don't think it's appropriate to comment on the comments yet. We're still early in the comment period, and I'm sure we'll be hearing from many shareholders with many points of view, and I welcome that.

InformationWeek: There's talk that the Health IT Policy Committee wants to recast the Nationwide Health Information Network as a set of policies, rather than a physical network that connects many different health information exchanges in the country. What's your vision for the best approach for providers to exchange of health information?

Blumenthal: Congress made it clear that the exchange of health information is a high priority. They included it as an essential part of meaningful use.

That's consistent with the general view that a lot of the value of health information comes from the ability to improve care coordination, to make records and information more complete, to enable physicians and clinicians of all types and hospital personnel to have a complete picture of a patient's health and healthcare so that they can make better decisions.

The Office of National Coordinator is still committed to developing the Nationwide Health Information Network. Many of our federal colleagues and quite a number of larger healthcare organizations are on the verge of using NHIN as it was originally conceived and configured for their own purposes, and we're continuing to invest in it.

At its last meeting the HIT Policy Committee adopted recommendations that they have not yet formally transmitted to me to encourage the development of a more flexible, adaptable, less complicated method of health information exchange than the Nationwide Health Information Network. And that's something that we'll be studying.

InformationWeek: How is the Nationwide Health Information Network being simplified?

Blumenthal: We have an obligation to make it possible for healthcare providers to become meaningful users of electronic health records. That's going to mean giving them options for exchanging health information—practical options.

It may be that those options will change over time just as meaningful use changes over time. We want to make sure what we do is develop exchange capabilities that are available to hospitals, physicians, nurses, and other health professionals who want to exchange information, and make sure they're practical and feasible to do without all the resources that big institutions have at their disposal.

That's our policy goal--there may be a simpler way than a full NHIN to make that possible in the short term. At the same time, the traditional, full NHIN remains a commitment of the Office of National Coordinator.

We're thinking about whether there are compatible versions of the exchange that require varying levels of sophistication and resources to participate, and have varying levels of capabilities over time.

InformationWeek: Once you get clinicians using e-medical records, who pays to maintain the exchange infrastructure?

Blumenthal: It's a short-term issue. Long term it's going to become an expectation on the part of the clinician and patient that information is going to be exchanged. And I think it will become a cost of doing business in the healthcare sector just as physicians and nurses consider it a cost of doing business to buy stethoscopes and run an office.

InformationWeek: Now that the meaningful use definitions are near final, what's next on your agenda?

Blumenthal: We want to get out a regulation creating a certification process; we're working very hard on that. We have an enormous number of programs to implement that have been announced over the last two to three months. So that's a big challenge.

The Congress asked us to develop a governance mechanism for a nationwide health information network, and as soon as we have our options clarified on that [network] we'll proceed on that project.

And of course we have to finalize the [meaningful use] regulations that we've issued in a more proposed form. Then we have to begin thinking about what's next for meaningful use and those standards. We'll be looking at that towards the middle of 2010, anticipating that we're going to need to begin modifying meaningful use as a standard and certification criteria prior to 2013.

InformationWeek: Will the Certification Commission for Heath IT--CCHIT-- remain the organization doing these certifications, or will there be others?

Blumenthal: We'll have to see what the regulation actually is and see where CCHIT fits in. CCHIT is clearly going to have the option to participate in certification going forward, but I can't tell you what role exactly it will play.

InformationWeek: How confident are you that there'll be enough talent out there to get these healthcare systems up and running to meet the meaningful use deadlines?

Blumenthal: We're going to be training a lot of these professionals, and I hope we get them out in time. We're going to get them out as fast as we can.

Professional organizations indicate there are shortages. I think people who are IT trained are potential candidates for these jobs, but they need to ... understand the challenges of healthcare, the problems, the kind of cultures of healthcare delivery.

Those are the kinds of people we'd want to attract into healthcare, but we also want to attract people who might not be IT professionals but have knowledge of healthcare and see this as an interesting area for them. Our training programs for community colleges will provide a lot of the necessary skills, we hope.

Blue Cross of Northeast Pennsylvania, the University of Louisville School of Medicine, and a range of large and small healthcare providers are using mobile apps to improve care and help patients manage their health. Find out how. Download the report here (registration required).

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