Editor Bernie Monegain interviews David Blumenthal, MD, National Coordinator for Health Information Technology.

Bernie Monegain: What was your first order of business as National Coordinator for Health Information Technology?

David Blumenthal: The first order of business has been to implement the HITECH provisions of the federal American Recovery and Reinvestment Act, which is a huge challenge and something that we take very seriously. It’s also a huge opportunity because of the extent of the investment that the Congress has made in health information technology. What’s next? What’s next is the same as what starts because that is going to be a continuing priority for us getting to our responsibility to support the healthcare system in the meaningful use of health information technology.

BM: Will stimulus funds for healthcare IT give the push needed for substantial uptake?

DB: Well, it’s a very good start, and I don’t think the federal government has ever promised that it would purchase every physician every hospital, every nursing home, every nurse practitioner, every occupational therapist a health information system. What it has done is given very significant incentives to physicians and hospitals and other healthcare providers who will increasingly see this as inevitable and I think will decide that it’s better to get some help in doing what they’re going to have to do than to wait and not have help doing what they have to do.

BM: How will your experience as a practicing physician inform your new role as ONC chief?

DB: I wasn’t just a practicing physician, but I was also a user of an electronic health record. And, I was also a user of a certain age. I wasn’t born to it. I had to learn it. So I understand first of all how incredibly valuable an electronic record is. There’s no question that it made me a better physician, and I understand, I think, as a result of that which aspects add value to the daily practice – at least in primary care – and also what the minor annoyances are associated with the record.

BM: And you call it minor annoyances. It’s not one big annoyance?

DB: The encounter is overwhelmingly positive, but there are times when you try to do something new and it’s not immediately apparent how to do it, or that your system is upgraded and you have to learn a new way of doing something or learn a new function, and you always have to do that in real time – in flight – as it were, because there are patients waiting to be seen. So, I understand how that feels, and that gives me an understanding of the importance of the infrastructure support that we are providing through HITECH to physicians and hospitals.

BM: What is the chief challenge ahead in employing information technology too modernize the healthcare system?

DB: There are many challenges, but I think one of the biggest will be maintaining the trust of the public as we continue to roll out electronic health information systems. We’re going to try first of all to implement the enhanced privacy protections that are part of the law, and there are quite a number of those. We are also going to look carefully at new technologies that can improve privacy and security. Then, we are going to – I hope – aggressively communicate what we’re doing to the public so that they understand that we care about their privacy and their security and we’re working hard to protect it.

BM: Is the country well under way to creating a connected nationwide health information network?

DB: We’ve had some very successful demonstrations of the ability to connect disparate parts of the health system. We have to add to this technical capability for connectivity a regional capability to enhance exchange in local areas. There’s always been something of a dialogue between building a national network and building regional networks. I think it’s easier when resources are very, very short as they were in the previous administration to focus on the national network because to some degree that’s just a matter of just developing standards and prototypes rather than actually building out an entire network. Now we have funding. As a matter of fact, we’re required by Congress to use funding to support health information exchange at the sub-national and regional level. So, we’re adding a focus on regional and sub-national exchange that wasn’t present for lack of support and lack of resources in the past. We’re not de-emphasizing the national focus. We’re adding an additional focus.

BM: Aren’t a lot of these regional exchanges having trouble sustaining themselves or building a business model?

DB: It is true that there has been no business case for regional exchange, but the financial incentives that are part of HITECH create a new business case because one of the definitions of meaningful use by statute is the ability to exchange health information.

BM: What are you reading?

DB: I’m reading “Washington’s Crossing” (by David Hackett Fischer) right now. I’m about two-thirds of the way through. I think I’m going to read a mystery next. I tend to intersperse history with mysteries. But I’m not sure which mystery I’m going to read.

BM: Is there something else you’d like to emphasize that I might have neglected to ask?

DB: I’m aware that there’s a lot of uncertainty out there about what we’re planning and I would just want to reassure people that we’re working hard to …and hope in short order to have a lot of news about several things that are critical to making health information technology a lot more available.