Reason for optimism
After talking recently with former National Coordinator for Health Information Technology David Blumenthal, MD, there seemed to be reason to be optimistic about the promise of health information technology, about moving the healthcare system as we've known it – paper-based and clunky – to one that is digital and, well, less clunky.
There are many powerful minds at work on this massive change. But lately, it seemed, all the effort – and money – poured into the federal EHR Incentive Program might be for naught, with providers struggling to attest to Stage 2 meaningful use.
It's a matter of standards, interoperability and national will. That's essentially how Blumenthal, who is not given to hyperbole, sees it.
Of course, the questions remain: Will we develop the required standards? Will we solve the conundrum of interoperability? Can we make it a national priority?
At this point, the answers have to be "yes," "yes" and "yes."
There is evidence that the will is there – perhaps not nationwide, yet, but certainly evident in critical pockets.
"It was truly an amazing discussion," wrote John Halamka, MD, in a June 17 blog post, summarizing the June Health IT Standards Committee meeting, which focused on an update and evaluation of the standards and interoperability framework initiatives. "The energy in the room was palpable."
Halamka reported: "Everyone agreed that data provenance/integrity and support for query-based exchange via APIs were the topics we should work on.
"The entire committee came to a conclusion, representing independent opinions from a multi-stakeholder perspective that aligned perfectly with ONC's 10-year vision," he noted. "Per the recent ONC whitepaper, the goals of the next three years should be: provider and patient ability to send, receive, query, and use data; data provenance/quality and patient matching; and privacy and trust."
Standards are absolutely critical for moving forward on interoperability, Blumenthal says, and they require elbow grease.
We can't think of anyone with more elbow grease and stick-to-it-ness than Halamka and the hundreds of other volunteers who have worked on standards over many years. They are committed to doing it right. This work, it seems, has to be counted as a show of national priority.
"At our next meeting we'll drill deeper into a refinement of the standards and interoperability framework by asking what we are missing in the existing initiatives that is foundational to the ONC 10-year vision," Halamka wrote. "Although meaningful use is important, we need to think about standards beyond the confines of the next stage of meaningful use."
Then, there's John Loonsk, MD, calling for a HITECH reboot. Loonsk served as director of interoperability and standards at ONC from January 2006 to December 2009.
In a recent analysis piece he wrote for Healthcare IT News (read it on page 15), Loonsk offered his 10-point plan for a reboot. Among them is a call to double down on interoperability.
"The entire standards, implementation guidance and certification process needs a boost to achieve just a strategic sample of the transactions needed in health," he wrote. "There needs to be a broader, more inclusive, standards process. The ONC Standards & Interoperability Framework has good ideas, but there are many more needs than ONC alone can promote. There are also needs for broader standardization and specification of technologies beyond just data and messages. Constructively re-engage the industry to help make this happen."
We believe the HIT Standards panel is listening – and will take Loonsk's point to heart.
Another one of Loonsk's points with which Blumenthal and many other health IT leaders would agree:
"Stop talking only about EHRs! EHRs are part of a much bigger HIT ecosystem. They are like the leaves on a tree. There must also be branches, a trunk and roots. There are networks and hundreds of other HIT systems that support ancillary organizations and activities, population health and healthcare."
Yes, indeed. And, that brings us to another former ONC chief – Farzad Mostashari, MD – who recently launched a startup to help primary care physicians create physician-led ACOs. Mostashari and his team will create a "cutting-edge" technology platform, Mostashari told us. That means so much more than an EHR.
"There's a whole series of tools that we will build or buy to help manage the population risk – so predictive modeling, figure out who's going to be admitted to the hospital, integrating clinical and claims data into that," Mostashari said. "It's the network analysis, figuring out who you want to refer, are they actually following through on the compact they've made, it's admission/discharge/transfer notification; and it's patient relationship management."
Among all of these ideas and all of this work, and in spite of high hurdles along the way, we find several reasons for optimism.