The Role and Future of HIT in an Era of Health Care Transformation

Today I'm at George Washington University's "The Role and Future of HIT in an Era of Health Care Transformation Symposium" serving as moderator of a panel discussing the barriers and enablers to health information exchange, including the impact of PCAST Work.

We began the day with an introduction from Dr. Alfred Hamilton, assistant professor, The George Washington University School of Public Health, and Dr. Ward S. Casscells, professor of medicine and public health, The University of Texas Health Science Center at Houston.   Drs. Hamilton and Casscells organized the conference so that stakeholders and policymakers could discuss barriers and enablers to creating a connected, learning healthcare system.

Paul Egerman, retired CEO/software entrepreneur, educated the group about the PCAST report's main ideas - accelerating interoperability through the use of a universal exchange language (UEL) and a data element access service (DEAS).  Reviews of the report thus far have raised policy and operational feasibility concerns, suggesting  pilots and an incremental approach to implementing its ideas.  The Office of the National Coordinator has released an Advanced Notice of Proposed Rulemaking containing the PCAST-related metadata recommendations from the HIT Standards Committee.   As a next step, PCAST ideas will be tested using CDA R2 headers to identify the patient, the provenance of the data, and privacy flags, ideally in the PHR to EHR data exchanges described below.

Dr. Stephen Ondra, White House Office of Science and Technology Policy, presented an overview of the impact that interoperability and data sharing will have on healthcare systems, providers, healthcare purchasers and patient advocacy groups.   He noted that HIT is not a goal in itself but is a critical foundation for health reform efforts.  The Obama administration has recommended a portfolio of approaches rather than one size fits all health information exchange.   Choices include query/response "pull" (Exchange type), directed "push" (Direct type) and consumer based viewing (Blue Button type).  

Dr. Farzad Mostashari, national coordinator for health information technology, discussed how interoperability and data sharing support the stages of meaningful use.   He identified the issues we've all been diligently working on - standards, governance, architecture, creating trust, and sustainability.   He thanked the HIT Policy and HIT Standards Committee for their hard work- an average of a meeting every other day for the past 2 years.    He noted that our policy drivers are quality, safety, efficiency, public health, and patient centeredness while protecting privacy and security.    He emphasized the use cases with early wins - laboratory report exchange, e-prescribing, and patient summary sharing.   He suggested the need for bold incrementalism - balancing innovation with the reality of implementation cost and timing.    The recent debt ceiling negotiation illustrates that we cannot afford to pay for more healthcare quatity, instead we need to pay for quality and value.  Healthcare IT is foundational to new reimbursement models and needs to be available for every stakeholder, large and small.

I had the opportunity moderate a panel discussion of policy and technology enablers and barriers to healthcare information exchange.   Participants included

*Dr. Farzad Mostashari
*Dr. Stephen Ondra
*Ms. Christine Bechtel, vice president, National Partnership for Women and Children
*General Douglas Robb, joint staff surgeon, Office of the Chairman, Joint Chiefs of Staff, the
Pentagon

Major themes of the dialog included

*Consumers can be effective stewards for their own summary data and care plans, but there needs to be standards-based, easy to use, automated interfaces between EHRs and PHRs before there will be significant adoption of PHRs.  One easy way to do this is a certification criterion for every EHR and PHR to support the Direct specifications, enabling providers to send patient summaries to any PHR without requiring custom interfaces.   PHRs need to be more than just passive containers for data.   Ideally there will be an ecosystem of applications which enable patients to seek second opinions, obtain personalized educational materials, and enroll in clinical trials using their PHR data.

*Although HITECH incentives are great in the short term, the best way to foster healthcare IT adoption in the long term is to ensure it supports workflow, saving time and bringing value-added services to providers, payers, and patients.   John Rother from AARP noted that online appointment making, referrals, and medication renewals have high value to patients.  Such transactions are not typically offered by standalone commercial PHRs.

*The culture of healthcare needs to be changed so that providers and patients expect healthcare information exchange at every patient encounter.   A culture change will create market demand for healthcare information exchange.   Patient and provider trust in the data integrity and privacy of healthcare information exchange is a pre-requisite to culture change.

*Healthcare reform will create incentives for health information exchange, since payments for wellness will require community-wide care coordination and decision. support.  The Patient Centered Medical Home is likely to become an electronic medical home that receives all data about patients from labs, pharmacies, hospitals, specialty practices, and home care devices.

*There needs to be innovation in care models, services, and technologies.   Although the government can catalyze innovation, the private sector will need to fund ongoing efforts, since grants are only short term and are not a sustainable business model.

The audience was very engaged in the discussion and there will be a whitepaper summarizing the conference.  A great meeting.   Thanks to Drs. Hamilton and Casscells for organizing it!