A Conversation with ONC’s National Coordinators – Past and Present (International Ballroom)
- Moderator: Janet Marchibroda, Director of Health Innovation, Bipartisan Policy Center (@BPC_BipartisanWeb Site Disclaimers)
- David Brailer, M.D., Ph.D., Managing Partner & CEO, Health Evolution Partners
- Robert Kolodner, M.D., Vice President and Chief Medical Officer, ViTel Net
- David Blumenthal, M.D., President, The Commonwealth Fund (@DavidBlumenthalWeb Site Disclaimers)
- Farzad Mostashari, M.D., M.Sc., CEO, Aledade (@Farzad_MDWeb Site Disclaimers)
- Karen B. DeSalvo, M.D., M.P.H., M.Sc. (@KBDeSalvoWeb Site Disclaimers)
Janet Marchibroda moderates a panel of ONC National Coordinators
“We stumbled in to the Health IT Movement”
A passion and sense of purpose and creativity in the Health IT community. It is remarkable that this passion has been maintained over 10 years.
Initially it was about resolve to get action in legislators and in congress. Now it needs to evolve. What has changed is that the health care industry has caught up with Health IT. HIT is very real and an essential part of care delivery.
Health Care is now demanding more from Health IT.
February 2009 and the HITECH Act became law. The great recession and the ARR Act. This was about economic recovery. It laid the groundwork for the reforms in the Affordable Care Act. Policy development and implementation in a 12 month period. Setting direction in face of uncertainty.
What has changed most is that this was a top down effort to alert the Health Care community to the potential of HIT.
Taking over from the entrepreneurial phase under David Brailer and the challenge was to use scarce resources to lay a foundation while people had high expectations and wanted to see real progress. Now we have resources in place we can now make a real impact on health.
The challenge is now to use the resources in place and deliver real impacts on person-centered health. Now we need to build towards the learning health system.
Things weren’t as smooth as it appears now in hindsight.
Meaningful Use Phase 1 had been put in place. Top of mind was execution. Also need to help the people on the front line deliver and implement. Time lines were incredibly compressed.
Now it is time to iterate and improve. People need to optimize policy and implementation.
Building on a strong foundation. The last year has been moving off the era of HITECH funding. Data is available and can be shared. There are promising models in operation. Also a great environment where the culture has changed. Health is more than just health care.
Payment reform is driving the realization that sharing health information is critical to delivery of better care and aligned rewards.
What is next beyond just interoperability?
Brailer: We can’t support population health management and payment reform without interoperability. The industry won’t get a breathing space. There are 2 worlds of interoperability:
1. The heavily architected, non-scalable architecture for data sharing.
2. Lighter, less mediated and peripherally managed policies
Hope that the comment period on the roadmap will bring clarity in this area
Mostashari: Remember feeling the impatience but docs couldnt get lab interfaces, couldn’t e-prescribe and couldn’t e-bill. Simple transactional issues.
e-prescribing has gone from 1% to 80% plus.
Small practices can’t get their own data out. Not because of technical standards but because of their business practices. Vendors don’t have same incentives as providers. This is a market failure. Standards reduce the cost of interfacing. Will they reduce the price?
Bluementhal: Information exchange is a team sport.
We want competition yet we want people to collaborate and share their most valuable information and if they do then the FCC will target them for Anti-trust activities.
Kolodner: For the ONC the issue is Transparency. Who is doing a good job? We need to understand how organizations are performing.
DeSalvo: Three areas are critical pathway to the Learning Health System:
- Change way we pay for care
- Change way we deliver care
- Share information
Use existing payment structures and link to quality results.
Kolodner: What can other agencies do to drive change? VA and DoD use Private Sector to deliver care. This will drive information exchange.
Medicare and Medicaid hit one part of the market. DoD and VA can help in helping the nation’s veterans.
Mostashari: VA, DoD and CMS did and is doing great things with BlueButton
How will congress influence
Brailer: Didn’t have a great relationship with congress since they reduced ONC budget to zero. Level of HIT IQ has gone up on the hill. Hard to imagine this congress acting on Health IT or on Healthcare. Wish they would rethink HIPAA. It stands in the way of interoperability.
A simple business model question: “Health Information Sharing is a Covered Benefit”
Bluementhal: ONC had to maintain confidence around the industry to avoid resistance to change. MU3 may see some push back from Congress. Toughest legislative challenge is around security and privacy. HIPAA has gaps and flaws that jeopardize interoperability. Don’t expect change in the current congress.
Words of Advice for ONC and HIT?
Brailer: Be very aware of the tremendous world that has been created by innovators and entrepreneurs to change Health IT.
Kolodner: Environment keeps changing. Recognize the different forces and be ready for change. Keep focused on the interests of the population. Keep listening.
Blumenthal: The time is right for a real push on interoperability. The culture of change is in alignment. Keep pushing and go for it.
Mostashari: The role of the National Coordinator is a dual role. Leader of an agency of committed civil servants. Also a representative of a passionate community that have different perspectives. Represent and synthesize these voices.
Q: Market Failure. Vendors using barriers to interoperability will be de-certified (proposed in budget)
Kolodner: having the noose in place may dissuade the market
Q: @FredTrotter: Epic hasn’t have a reputation for interoperability. How can we know a vendor is friendly to interoperability? How can we get clarity?
Brailer: If a vendor has significant market share they do not prioritize Interoperability. This is because Vendors have been asked to solve an enterprise integration problem.
DeSalvo: Encouraging signs since October with things like project Argonaut http://2.healthca.mp/1zPx1n6 This is encouraging.
Q: Could selection of Dod/VA EHR impact interoperability.
Kolodner: Interoperability is a big part of EHR requirements since VA/DoD needs to share with private sector providers. VA has been a leader in interoperability. Also disruptive effects of mobile apps. Consumers must demand our information. Not just flat but rich types of data.
DeSalvo: An incredibly important decision. It is a catalytic investment opportunity in the healthcare marketplace.
Q: Why are we not taking more advantage of health care dollar savings?
DeSalvo: Coalesce around a core set of standards that support interoperability. We have to recognize trusted entities.
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[tag health cloud, blue button, ONC2015]
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I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.
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