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10/25/2011
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Q&A: Blumenthal Talks EHRs, Healthcare Reform

President Obama's former national coordinator for health IT, Dr. David Blumenthal, shares his thoughts on progress with meaningful use of electronic health records, and what's next for healthcare reform.

During his two-year stint as National Coordinator of Health IT, Dr. David Blumenthal oversaw the development and implementation of the American Recovery and Reinvestment Act's $27 billion HITECH Act stimulus programs to encourage the adoption and "meaningful use" of electronic health records by hundreds of thousands U.S. hospitals and clinicians. Blumenthal--a former primary care physician at Massachusetts General Hospital--left his Office of National Coordinator job in April to return to his tenured post at Harvard. InformationWeek Healthcare senior writer Marianne Kolbasuk McGee caught up with Blumenthal at the recent Partners Healthcare's Connected Health Symposium in Boston.

InformationWeek: What do you think of the progress so far with the Meaningful Use programs?

Blumenthal: There are 114,000 registrants, which is 20% of the eligible population, and we're only halfway through stage one and Meaningful Use incentives last through 2015. So I think everyone wants to know if we are ready to declare victory, and the answer is that I'm encouraged by the progress, but I think it's too soon to make conclusions. It's encouraging that a fifth of the eligible population of providers have registered, and it's encouraging to see that upward of 6,000 have gotten paid, even though only 20 states have gotten their Medicaid incentive programs up and running. So, the whole Medicaid population is still not yet able to participate because the states just aren't giving away the money. I think also pretty soon we'll have ready additional data on EHR adoption, and I expect it will be very positive. Meaningful Use is one standard, but getting people to electronic health records so that they can build into Meaningful Use is another important thing.

InformationWeek: What will happen if healthcare reform is repealed after the next presidential elections--what would be the impact on the reforms closely linked to health IT, such as accountable care organizations?

Blumenthal: The question that will come up is how assertive will the next administration be in using all the authorities available to facilitate healthcare reform. Everything that they need is on the books--the question is will they use it and also will it stay on the books.

I think probably the authority that's most vulnerable is the center for Medicare and Medicaid innovation because there is $10 billion assigned to it. So, it's a relatively flexible and therefore pretty easy tool for the government to use in showing leadership. And I don't know whether the next administration will believe the federal government should be leading with innovation in health reform or health delivery systems. What happens with ACOs I think will again depend on the philosophy and inclination of the next administration. None of these things get implemented by themselves. They need a lot of nurturing. They need a group of people who are committed to a significant government leadership role. So the question is: What will the attitude be in the next administration, and I don't know.

I think some of the system reform elements of the [health reform] legislation have bipartisan support. Yet, individually they are not going to change the landscape. I think they need to be knit together in fairly concerted, coordinated, well-planned efforts to change the way complicated patients are treated. So I am concerned that implementing each individual provision of the law without an overarching vision and goal will not get us to where we need to go. And that's true of IT as well. The successful implementation of the IT project depends on the government and health system using IT with the purpose of health improvement.

InformationWeek: Besides the adoption of EHRs, what other technology do you think will have the biggest impact in terms of improving quality of patient care, reducing costs?

Blumenthal: Clinical decision support is really pivotal. I think that's a very important capability--and then the ability to exchange information. Those are part of the agenda and they need to be built into the capability of EHRs. But they won't be unless there are incentives to do so. Meaningful Use will emphasize those, I'm pretty confident. But there will be push back from the provider community if the technology is not ready, is expensive, or changes their workflow.

InformationWeek: Once the Meaningful Use programs end, do you think use of health IT will stall?

Blumenthal: The programs don't end. They change from incentives to penalties, till 2018--so that's another seven years. And I think we're already close to turning a corner. Now I think psychologically people have shifted their view of electronic records in medicine. Meaningful Use kind of held up a mirror to the industry, where the industry said, 'you know, really how can we ignore the information technology revolution.'

InformationWeek: What do you think the big hold ups are on the consumer side in expecting this capability?

Blumenthal: Well, it would be really nice if consumers got behind this, but I think it will take a little while. I think consumers also need to go through a mind shift as well about who manages their health, and maybe come to see that they can be more knowledgeable without threatening their physicians or taking away their physicians' roles. Most people are reluctant to push their physicians or challenge them. And they know their physicians are busy and if they value their relationship with their physician they don't want to do anything to upset that.

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