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4/11/2011
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ONC Employs Social Media For Input On Strategy

The Federal Health IT Strategic Plan proposed revisions are available for public comment on the Health IT Buzz blog maintained by the Office of the National Coordinator for Health Information Technology.

Slideshow: Who's Who In Healthcare IT
Slideshow: Who's Who In Healthcare IT

The Office of the National Coordinator for Health Information Technology (ONC) last week said it's accepting comments on proposed revisions to the Federal Health IT Strategic Plan through April 22 via its "Health IT Buzz" blog. This experiment in social media means that all comments are publicly viewable right on the blog page.

The 80-page proposal is the first update to the strategic plan since 2008 and spells out ONC's strategy for meeting national health IT goals from 2011 through 2015.

The revision, required by the HITECH section of the American Recovery and Reinvestment Act, considers "the rapidly changing landscape of health IT and health IT policy that has been drastically altered over the past years by two major pieces of legislation that have established an agenda and committed significant resources to health IT-the HITECH Act and the Affordable Care Act," recently departed national health IT coordinator Dr. David Blumenthal wrote in a March 25 blog post at "Health IT Buzz."

The proposal sets the following goals for the next five years, starting when medical care entered a new era-the age of meaningful use," according to Blumenthal.

-- Achieve health information exchange via "meaningful use" of electronic health records (EHRs) and other health IT.

-- Improve healthcare, improve population health, and lower healthcare costs with health IT, as called for by the National Health Care Quality Strategy and Plan that the Patient Protection and Affordable Care Act requires.

-- Inspire confidence and trust in health IT by assuring privacy and security of electronic health information and educate providers and the general public about privacy and security of health information.

-- Use health IT to empower individuals to make better choices about their own health and create a patient-centered healthcare system.

-- Build a "learning health system" based on technological advancement that aggregates, analyzes, and applies health information to improve care across populations.

Through Monday afternoon, 62 comments had been posted in response to Blumenthal's post. More are on the way, according to Thomas P. Caruso, a health IT consultant who is putting together comments on behalf of the Biomedical Informatics Think Tank, a group of 16 informatics professionals at several major academic medical centers.

Among those who have already posted, someone identifying herself as Renee Tweneboah-Koduah said current health IT efforts don't adequately answer questions about such roadblocks as data ownership, user identity, and liability for use of incorrect data. She also advocated for a unique patient identifier, something that the 1996 HIPAA legislation called for but that Congress effectively blocked in 1999. "I approve of the goals and overall strategy but I question their viability without significant changes to federal and state laws and aggressively addressing sensitive issues like identity and privacy," this person wrote.

Another poster, "Elisa Gorton," asked about protections for "high-risk" protected health information (PHI) on subjects like mental health and substance abuse. "Will these records remain at their current level of privacy and confidentiality or will the state and federal regs governing this PHI need to be changed to reflect the changes in this new legislation? How will we be able to ensure that 'high risk' PHI is only released with specific authorizations?" she asked.

"Donald W. Simborg, MD," said the proposal "continues to ignore healthcare fraud as a legitimate responsibility of healthcare IT in general and ONC in particular." If this is the real Simborg, he is the co-founder of Health Level Seven, started two EHR companies, and was a founding member of the American College of Medical Informatics.

A clinical psychologist and health IT developer, identified as "Stephen Beller PhD," called for greater use of "loosely coupled" social networks to connect clinicians with researchers and IT professionals across organizations. "These diverse groups of professionals would represent a 'whole-person integrated care' approach that addresses biomedical, psychological and mind-body (biopsychosocial) factors/problems/conditions," he wrote.

This is on the right track, according to Caruso. "The real HIT impact is going to be with regards to research," he said.

"There's tremendous potential to promote personalized medicine," Caruso added. "In my eyes, that's so important in being able to drive costs down."

From the patient perspective, "Tony" expressed frustration at the slow pace of adoption. "Health IT is rolling out like molasses on a winter day in Vermont. What could possibly be so darn hard?" this person wondered. The answer, he said, is for more patients to refuse to abide by the old way of doing things, such as by leaving medical practices that insist on making them fill out insurance and medical history on clipboards when they bring in data printed from a patient-controlled health record.

A significant number of comments so far have addressed meaningful use rather than the broader strategic plan, however. "Getting EHRs in place is only the first step," Caruso said.

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