My Hopes and Expectations for the Next Year

Many people have asked about my hopes for the next year, now that $2 billion is being allocated for health information technology through the American Recovery and Reinvestment Act of 2009 (ARRA)

Here's a summary of the ARRA legislation as I understand it:

*20 billion for Healthcare IT stimulus activity

*2 billion to ONC, including grants and loans available through an HIT Extension Program, with a national center and regional centers that provide outreach to help providers adopt through advice on "good technologies and good implementation strategies

*New Standards and Policy Federal Advisory Committees.

*Standards are voluntary for private enterprises, but must be in place for all federal contracting and stimulus initiatives

*Competitive planning and implementation grants to states

*Competitive grants to providers that require providers to participate in quality reporting and present strategies for upgrading and
maintaining system in the future

*A demonstration program to apply health IT training to clinical curriculum

*Grants for IT professionals to expand health informatics training.

*Medicare and Medicaid incentives start in 2011. Year 1 will be the largest payment and over time will become a disincentive/penalty for non adoption.

After many discussions with the leadership of NeHC, CCHIT and HITSP, my hope is that NeHC becomes the Standards Committee referred to in the bill and that the great folks already chosen to serve on NeHC continue their service. The NeHC as configured is multi-disciplinary and not dominated by any one group. The new Standards Committee should continue to provide Value Case, as described in the NeHC charter, to prioritize standards harmonization, architecture and best practices needed to ensure interoperability.

It is my hope that HITSP continues to serve as the multi-stakeholder group doing the standards harmonization work requested by the Standards Committee. HITSP's current configuration is not dominated by any one group (vendor organizations are 44% and have not been a majority of any vote) and includes the following membership:

Consumer – 22 organizations
Govt – 45 organizations
Non-SDO – 458 organizations
SDO – 28 organizations
Project team – 12 organizations (non-voting)
Information only organizations – 91

Non-SDO breakdown:
Clinicians – 32
IT – 44
Payer – 21
Provider – 33
Public Health – 18
Purchasers – 4
Researchers – 20
SafetyNet – 10
Vendor – 252
Chose no subcategory – 24

I do believe HITSP will evolve its approach to producing interoperability specifications. Specifically, its deliverables in the future will include highly reusable service oriented architecture components for content, transport, and routing. Our HITSP meeting on Friday will include a discussion of the work we've done over the last year to evolve our future approaches into this SOA methodology. This means that HITSP documents will be much easier to read and implement, more reusable, and more nimble to rapidly support uses beyond the scope of the current use cases. We'll also complete a dictionary so that implementers can easily reference data elements and then create services themselves to exchange data. For example, if a vendor or HIE wanted to exchange problems, medications, allergies, notes, labs results, and radiology reports, then it would be as simple as referencing the data element dictionary, implementing the content standards (such as CCD with RxNorm and SNOMED-CT vocabularies), the transport standards (HTTPS with SOAP or REST), and the routing (query/response or publish subscribe framework such as XDS or XDR). I expect at least one of our 2009 Interoperabilty Specifications to pilot this approach and I am hopeful that this emphasis on XML and the standards of the web will accelerate implementation in 2010 and beyond.

HITSP has had a great relationship with CCHIT to ensure interoperability specifications are introduced in a stepwise manner to ensure all stakeholders can adapt to the changes without too great a burden. I am hopeful that CCHIT will continue its task doing certification. I believe NIST will also be involved, advising us all on best practices for standards conformance testing and certification.

The next year will also bring much planning for the implementation of EHRs regionally and locally. My top expectations for 2009-2010 are

1. ONC will be recognized and will become a sub-cabinet organization, given the authority and resources needed to accelerate the adoption of electronic health records and standards-based information exchanges.

2. ONC will fund regional "IT Extension Centers" to provide project management and implementation services to small practices nationwide.

3. NeHC will become the standards committee and will create value cases that contain standards and architecture for HITSP to harmonize and CCHIT to certify.

4. Medicare and private insurer incentives will accelerate implementation of a few basic data exchanges - laboratory, e-Prescribing and clinical summaries. Local, regional, and domain-based (such national lab vendors, Surescripts/RxHub) health information exchanges using mandated standards will provide a network of networks for such exchange.

5. Public good data exchanges such as quality measurement, biosurveillance and public health reporting will be required for participation in Medicare HIT incentives. Other data exchanges such as home monitoring devices and clinical research will follow.

$2 billion is a great deal of money. However, the scope of the work to be done - providing electronic health records to over 600,000 doctors, it will only lay the foundation. Through a focus on regional IT extension centers, great governance via the Standards Committee working with HITSP/CCHIT/NIST, and a prioritized list of required information exchanges, ONC will be empowered to bring EHRs in the US to the next level.