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Q&A: Straight Talk From the New Health IT Czar


 

In March, Dr. David Blumenthal, a Harvard professor and a senior health adviser to President Obama's campaign, was appointed to the position of National Coordinator for Health Information Technology in the Health and Human Service Department. He is assuming the post at a critical time, with Congress recently setting aside billions of dollars in incentives for physicians and hospitals to adopt health IT as part of the American Recovery and Reinvestment Act.

In an interview with this news organization, Dr. Blumenthal talked about some of the challenges and progress so far.

OB.GYN. NEWS: As a primary care physician, what do you see as the biggest challenge for physicians in adopting interoperable electronic health records by 2014? Cost? Misaligned incentives? Products that don't meet their needs? Security?

Dr. Blumenthal: Surveys have shown all of those to be issues. I think security is a lesser issue, according to the surveys that my group did at Harvard when I was there. But the cost of acquisition, the lack of return on investment, [and] concern about the usefulness of products all ranked high in our survey results. So I think all are important issues for physicians right now.

OB: The Recovery Act includes about $17 billion in incentives for physicians and hospitals to adopt health IT. What impact do you expect this to have on the sluggish adoption rate and the health IT marketplace?

Dr. Blumenthal: Let me first make a minor correction in the number: $17 billion is a Congressional Budget Office number and it is actually a combination of two numbers: a spending number and a cost savings number. Both are estimates. The actual CBO projections of spending are about $29 billion, and they project a $12 billion savings, which gets you to $17 billion. Some estimates of the spending are that it will be considerably higher than that, and how much is spent depends on how many physicians adopt, how many hospitals adopt, and how fast they adopt. So if we think more on the order of $30 billion or even more than that, I do think that's enough to change the dynamic in the marketplace.

We are also counting on peer-to-peer influence and on a growing appreciation among physicians of the value of health information technology and of the fact that it will be difficult to practice up-to-date, high-quality, professional medicine in the 21st century without an electronic health record. We are counting to some degree on professionalism to complement the incentives.

OB: Can you say where there is consensus so far?

Dr. Blumenthal: I don't want to get into specifics, but I will tell you that I think the consensus is clear around one thing, and that is that we should concentrate on performance and usability rather than on technical specifications. We should be constantly linking our definition of meaningful use to clinically meaningful capabilities and performance attributes.

OB: You and the president frequently have said that health IT is a tool, not a fix for our health care system. What can we reasonably expect to achieve through the widespread adoption of health IT in terms of reducing health care spending? And can physicians expect to realize any of those savings within their own practices?

Dr. Blumenthal: I think you've correctly captured my view of the role of health information technology. There are three essential components for achieving the president's goal and the administration's goal and, I think, the public's goal for a higher-performing health system.

The first is better information on what works and what doesn't in the daily practice of medicine.

The second is the ability to apply that knowledge rapidly to practice. And it's in that setting that I think health care information technology becomes a vital tool. It enables practitioners to access in real-time and have the benefit of … the latest information that is approved by their peers and recognized by their peers as valid and useful for patient care. And it helps overcome the human factors that limit the ability of clinicians to do their best at all times and in all places. Of course, it provides better information about individual patients to factor into decision making as well.

The third element is changes in the financing and organization of care that make it more valuable and more rewarding for physicians and easier for physicians to take cost and quality into account when they make their decisions.

Health information technology is the major part of the second [component], but can't function optimally unless all three are in place. So we are vitally dependent for the savings and the quality improvement that could come out of HIT, we are vitally dependent on health care reform more generally.

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