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7/22/2010
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Q&A: Dr. David Blumenthal On Getting Doctors On Board With EHRs

Nation's health IT coordinator discusses what's at stake for doctors, the potential for consolidation in healthcare market, and what the government is doing to secure e-health records.

The U.S. Dept. of Health and Human Services this month is finalizing the much-anticipated requirements for what constitutes the "meaningful use" of electronic health records. Those requirements will let healthcare providers know what they must do to qualify for the more than $20 billion in incentive funds set aside as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. It's expected that many healthcare providers who haven't deployed EHRs yet, will do so after the meaningful use requirements are released.

InformationWeek editor at large Marianne Kolbasuk McGee recently spoke to the nation's health IT coordinator, Dr. David Blumenthal, about what's at stake as healthcare providers, especially smaller ones, start deploying and using EHRs.

InformationWeek: Why is it important to hospitals for doctor practices to get on board with health IT and meaningful use?

Blumenthal: In future stages of meaningful use our goal is to make sure that information follows patients. Organizations that participate in the care of patients must support the gathering of information in ways that meet the full needs of patients regardless of where they get their care. So if you're a hospital in a city and a patient gets specialty care in a network of physicians or at a hospital other than yours, I expect the criteria for meaningful use to take into account the ability of hospitals to move information to those other specialty providers whether or not they're affiliated.

InformationWeek: Will rewards or penalties be tied to the ability to exchange medical information?

Blumenthal: From a policy standpoint, an aspirational standpoint, the Department of Health and Human Services--and I think the Congress--is very clear on where we want to go, and that's to have information follow patients. That's to have information that's generated in any part of the health system to be available to every other part of the health system that takes care of that single patient. We don't want information to be stopped at the border of a health system, a commercial boundary, or a geographic or political boundary. Ultimately we don't even want it to stop at national boundaries. We want this to be about patients, not about the technical or business concerns of providers.

InformationWeek: What are the biggest risks to doctors who don't get on board besides the financial penalties that will eventually kick in?

Blumenthal: First of all, any doctor who wants to sell his or her practice or who wants to recruit a partner to give new life to the practice or to expand it will have a lot of trouble recruiting a young physician--someone under the age of 45--if they don't have an electronic health record or don't plan to acquire one. This new generation of physicians isn't going to tolerate a paper world.

InformationWeek: So the excuse that you're a doctor who'll be retiring in a few years isn't a valid reason not to implement EHRs?

Blumenthal: If you're a 50- to 60-year-old physician, you're in the prime of your professional career and your patient panel is expanding. You probably want to bring on a new partner--maybe two or three--so you'll be recruiting. There's a physician shortage, so what's going to make your practice competitive?

InformationWeek: Will the move to health IT and meaningful use lead to consolidation of the healthcare marketplace?

Blumenthal: That's one possibility. And there has been a tendency among physicians to go into employed situations over the last decade. But I want to make it clear that it's not our purpose or goal to undermine solo or small group practices. The acquisition of electronic health records can make those practices more sustainable over time and enable them to maintain their independence if they wish. It may be a little harder for them to get over the hump of acquisition than if they were part of a group or large organization, but they can share data with a larger organization through an electronic health record and maintain their independence using electronic means better than they could in the paper world.

InformationWeek: The HITECH act was signed into law about a year before the nation's healthcare reform legislation finally passed. Anything you now think is missing from the HITECH legislation that needs to be addressed?

Blumenthal: We will certainly learn in which ways electronic health information systems can better support health reform over time, but I think now we have a huge, very innovative mandate. If we can just do what the Congress asked us to do under HITECH, we'll have gone a long way toward making health reform more successful. I'm just hoping we can fulfill the expectations of Congress and the administration within the current HITECH authorities rather than looking forward to new pastures to graze in.

InformationWeek: In terms of mass adoption of health IT, how will it help the so-called Accountable Care Organizations? (ACOs are organizations where a doctors and hospitals manage all of a patient's care and share in the savings from providing better care.)

Blumenthal: The Accountable Care Organizations are organizations intended to hold themselves accountable to performance standards and can perform at a higher level. How do you hold yourself accountable? Through measuring what you do, looking at what you do, understanding what you do. How are you going to measure what you do without timely, accurate, comprehensive information? Where are you going to get that information in a paper world? Paper chart reviews are just not adequate. They're not accurate enough. They're not robust enough. They're not timely enough, and they're too expensive. So I think the ACO mission and agenda almost presumes the availability of electronic health information.

InformationWeek: So, if you're not using EHRS and other high-tech tools, you really can't be part of an ACO?

Blumenthal: It's possible to do with extraordinary effort. There are some organizations in the paper world that perform better than others. And with great effort and considerable cost, it's possible to document that. But the documentation has never been complete. It almost always has relied on claims data and was never adequate to really maximize the potential of those organizations and give healthcare providers with real-time feedback on their performance—the moment-by-moment kind of feedback you can get with an electronic health environment.

InformationWeek: Patients and consumers get uneasy sometimes when you talk about digitizing their health information. They worry about privacy and security. Are there plans to address this?

Blumenthal: The HITECH act enacted a whole series of provisions to tighten the privacy and security laws under HIPAA. And the Office of Civil Rights has already issued an interim final rule on breach notification that requires the notification of patients or other individuals whose data is breached. There's also a series of much harsher penalties for breaches due to negligence. There are a series of restrictions on the use of patient information for the marketing of products, for fundraising, or for other uses they haven't given permission for. These will begin to give the public some insight into what we're doing.

Beyond that we've begun working with the administration's cybersecurity czar to make healthcare a model program to tighten security of information in general. We're looking top to bottom at the security standards and technologies available to providers to protect health information.

InformationWeek: Some large medical organizations say a big concern about the proposed meaningful use rules is the "all-or-nothing" approach to rewards, which could hurt healthcare providers who attempt to meet all two-dozen or so requirements but come short on the last few. What do you think about a more scaling type of reward system?

Blumenthal: We've heard that concern and are looking closely at it. There were quite a number of concerns, not only about the number of requirements, but also about the threshold levels. So I suspect if some of the thresholds weren't as demanding, then maybe the concern about number of requirements might not have been so great. There are a lot of things to balance, and we're working on them.

InformationWeek: As you've traveled around the country and talked to healthcare providers, what are the top hurdles they're most worried about in deploying these systems?

Blumenthal: The concerns are the cost of acquiring the records, the technical challenge of putting them into place, and possible lost of productivity at first. They also raise questions about whether these systems will be compatible with their practice, their style, and their ability to do their work. That's mostly what's on people's minds.

InformationWeek: Now that the grants have been awarded for these programs, how will Beacon Communities and Regional Extension Centers help providers?

Blumenthal: Beacon Communities and Regional Extension Centers haven't been on the ground long enough to become household words in most communities. So many physicians aren't widely aware of the services they're providing. I hope that will change quickly. Some Regional Extension Centers are functioning, and some are still getting organized.

InformationWeek: In terms of getting the word out to providers about any of these efforts, is there anything you'd like to add?

Blumenthal: We're optimistic, we're moving forward, and we're deploying a whole series of new programs. We still have 16 months before providers have to demonstrate meaningful use. Under the notice of proposed rulemaking, it's not until Oct. 2011 when folks have to start documenting their meaningful use. We still have substantial time to provide assistance to people who want to get started.

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