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Saturday, April 5, 2014

A decade of Health IT progress

10 years after the revolution
Health IT coordinators look back at the nation's progress

By Joseph Conn, Modern Healthcare, April 5, 2014

On April 26, 2004, President George W. Bush formally launched the federal drive to widely disseminate health information technology to improve patient care. In a speech in Minnesota, Bush set a goal that within 10 years, “every American must have a personal electronic medical record,” adding, “The federal government has got to take the lead in order to make this happen.”

The next day, by executive order, Bush created the Office of the National Coordinator for Health Information Technology within HHS. A few days later, HHS Secretary Tommy Thompson named Dr. David Brailer the first ONC leader.

...He said the office should “not assume or rely upon additional federal resources or spending” to do its work. And in fact, later that year Congress zeroed out the ONC's $50 million budget request for 2005, forcing Thompson to finance the agency by reshuffling HHS' administrative funds.

The ONC was started “because America was clearly behind a lot of other developed countries with a health information infrastructure,” said Dr. Paul Tang, chief innovation and technology officer at the Palo Alto (Calif.) Medical Foundation who serves on several ONC advisory panels.

In its first decade, the ONC has had “an extraordinarily important” impact on healthcare, said Dr. John Halamka, chief information officer of Beth Israel Deaconess Medical Center, Boston. “Over the 10 years of ONC, we have tripled adoption of EHRs and brought health information exchange into the common vocabulary,” Halamka said.

Brailer was succeeded as ONC coordinator by Dr. Robert Kolodner, Dr. David Blumenthal, Dr. Farzad Mostashari, and now Dr. Karen DeSalvo. “Each of the coordinators has had a unique role to play,” Halamka said. “I would say each person was optimally chosen for the era in which they served and each had a totally different personality.”

There have really been two ONC eras—the little-money Bush era, in which the ONC ran on $50 million annual budgets, and the big-money Obama era starting with the 2009 American Recovery and Reinvestment Act, with its $2 billion for ONC grant programs. The incentive payment program for adoption of EHRs has paid out $21.6 billion so far.

In the beginning, the ONC was “a very strong idea” that was almost totally without funding, said Glen Tullman, a managing partner of 7 Wire, a Chicago-based investment firm, and a former CEO at Allscripts Healthcare Solutions. He credits Brailer and his top aide, Missy Krasner. “They single-handedly went around the country and used the bully pulpit to cajole and convince people that this was vitally important.” But Tullman added, “there is only so much you can do from the bully pulpit.”

There are critics of the strong federal role in HIT development, including Brailer himself. He describes the EHR incentive program as a market-disrupting “Frankenstein.”...

...ONC leaders point to an impressive list of achievements.

Before the ONC, caveat emptor ruled for EHR buyers. Today, virtually all EHR systems sold are tested and certified against a list of functional criteria developed by the ONC...

...[I]n September 2008, Wall Street's Lehman Bros. collapsed, touching off the Great Recession, which prompted President Barack Obama's economic stimulus package. Working as director of the Institute for Health Policy at Massachusetts General Hospital, Boston, Blumenthal wrote a five-page white paper, published by the Commonwealth Fund in January 2009, which hinted at many of the HIT provisions in the stimulus package.

His paper envisioned direct grants or loans to providers to support EHR purchases, as well as extra Medicare and Medicaid payments for adoption, and penalties for providers without them. It called for funding community-based “geek squads” to help doctors implement and maintain their systems. And it called for payments to incentivize improvements in quality and efficiency.

Blumenthal said he was not directly involved in drafting the EHR incentive provisions of the stimulus bill. But he did talk to Capitol Hill staffers and fielded calls on technical issues from the Obama transition team...

Mostashari came to the ONC as a deputy under Blumenthal after serving as a deputy health commissioner in New York City, where he established a program that helped more than 3,000 physicians install and use an EHR. He became ONC chief just as the EHR incentive payment program was taking off. “One of the things I'm proudest of is how we actually delivered value from the stimulus” money, he said.

One of his most important roles, he said, was “continually trying to raise peoples' eyes from what we're doing as a regulation to why we're doing this. The greater goal is to save lives.”

DeSalvo said she's spoken with all four of her predecessors. Although “they were dealing with different stages,” she said, “it's interesting to me that some of the general themes of what they were looking to do were similar. Everyone is trying to solve these same three issues—capturing data, freeing it appropriately and then putting it to use."

Interesting article. Full text here. Absent another economic calamity, the next decade will likely bring Health IT and healthcare advances we're not even thinking about today. I came into the Health IT world from banking analytics nine years ago in 2005 with the onset of the baby-steps DOQ-IT initiative. A much different landscape today. I observed in a recent post
One can only hope that we are on the cusp of exponential improvement in Health IT, that the next 5-10 years will see orders of magnitude of advances relative to the last. Nonetheless, technological advances may continue to be hampered by lethargic progress in reforming the health care business paradigm. That is where the principal difficulty lies.

Speaking of "10's"

Why You Should Have a Blog – 10 Great Reasons

1 – Everybody is interested in something.
And doing that favourite something is the quickest path to happiness and fulfillment that I know of. Therefore, it’s logical to conclude that writing a blog about that something is probably the most accessible way to make money around your favourite way of spending time.

2 – A blog will make you friends.
The very essence of a blog is that it will attract people who like the same things as you. They may see them very differently and they may well not agree with everything you say, but they will definitely share your interests. Isn’t that the very definition of friendships?

3 – Blogging encourages your creativity.
Even if you don’t think of yourself as creative, I am willing to bet that if you set yourself the challenge of writing three short blog posts about something you love, you will be amazed at how creative you can be.

4 – Owning a blog gives you motivation.

Once you begin to see the fruits of your efforts and especially when you start to get positive feedback from people you have never met, you will find that what looked like an onerous task at the outset is suddenly a pleasure to do – you can’t wait to see what your loyal readers will think of your latest post.

5 – Blogging gives you self-discipline.
Once you set yourself a schedule to regularly blog, you feel a responsibility to your readers to deliver on your commitment, but it’s a pleasure not a stress, because you know they are enthusiastically waiting for what you give them.

6 – Blogging keeps you sharp.
If you write a how-to blog, like mine, then you will be honing your skills of research and summation. If your blog is more opinion based, then you need to keep abreast of other views and the latest developments in your field so that you can comment on them with authority. You’ll find your thinking skills get keener and your ability to filter good information from bad gets a lot more efficient.

7 – Blogging is rewarding.
I guarantee that the best thing you will get from blogging is the satisfaction of making a difference to someone else’s life no matter how minor that difference might be. From a grateful reader telling you how much they enjoyed following one of your patterns to the person making their first few dollars online. The moment when you read their heartfelt email will be one of the high-points of your week.

8 – A blog is a test-bed.

Once you start to build an audience, your blog will become the place where you can try stuff out. You can ask their opinion on your plans and projects, test different offers with them and best of all you can get them to tell you what they need so you can make a product that suits, safe in the knowledge that as soon as you do, they are going to be the first ones to buy it.

9 – You don’t need to be a good writer.

No matter how poor you think your writing skills are, I absolutely encourage you to just get stuck in and start writing immediately. There are some great blogs out there written by people who are nowhere near polished, but they write with an intensity that makes that meaningless. In fact if they improved their writing, their blogs probably wouldn’t be as good. Their passion shines through.

10 – Google loves bloggers.

Every post you write, every picture you link and every comment you receive is another little building brick in the great structure of your credibility. The great bloggers out there have built their authority, their popularity and their credibility, by doing one thing well and doing it regularly.
Four, five, and six resonate with me in particular. Nine? Seriously? Though, to the extent that practice make perfect, you should indeed write a blog. Or books. Or whatever. Just write.

More to come...

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