Do the feds have a real plan to digitize medicine?
The office that President Bush created to promote interoperable EHRs has received $200 million since 2004, but still hasn’t produced a meaningful strategy to attain its goal, according to the General Accountability Office. But a plan is supposedly in the works.
The Bush administration created the Office of the National Coordinator for Health Information Technology, or ONCHIT, as a part of the Department of Health and Human Services in 2004. It was the same year that Bush announced that he wanted every American to have an EHR by 2014. Since then, ONCHIT has racked up several important accomplishments, according to written testimony 
submitted to the Senate budget committee earlier this month by Valerie Melvin, director of human capital and management information systems issues at the GAO. Melvin wrote that ONCHIT has funded efforts to certify EHRs, define standards to ensure that these programs can exchange data, create prototypes of health data networks, and keep data confidential without making it too hard to share.
However, Melvin concluded that ONCHIT has failed to “develop a national strategy that defines plans, milestones and performance measures” for reaching Bush’s goal of interoperable EHRs. Without such a detailed plan, the activities of the National Coordinator are uncoordinated, and progress toward the EHR promised land is hard to measure, she stated.
Reminders to get it together apparently haven’t helped much. Melvin wrote that the GAO had recommended in 2005 that ONCHIT develop a comprehensive roadmap for its work and had reiterated that point twice in 2006. ONCHIT says it will release a “Health IT Strategic Plan” in the second quarter of this year. The GAO will presumably give it a grade on effectiveness.
In her testimony, Melvin didn’t attempt to explain why ONCHIT hasn’t been a model of planning. She might have explored the subject of continuity of leadership. Internist David Brailer, the first person to fill the job of National Coordinator, was appointed in May 2004 only to resign in April 2006 (the following year, he helped launch a $700-million private-equity firm focused on health technology and services). The National Coordinator position was empty until psychiatrist Robert Kolodner was appointed on an interim basis in October 2006 (he gained a permanent appointment in April 2007).
[Via Medical Economics’ InfoTech Bulletin]
Sign up to receive Medical Economics’ InfoTech Bulletin newsletter, our update on medical technology news delivered every two weeks.
From Medical Economics magazine, more on EHR ...
Permalink
RSS
© 2007
Great article! They do have a plan, but the problem has been that doctors are fed up with the bullying, the pay cuts, and now the threatened forced-HIT which not only is costly, but frequently disrupts workflow.
For the first time one can see numerous initiatives and discussions against forced HIT. These are the ones that I’ve been following:
1) I’ve written to you about the introduction by a patient of mine to Congress of my “What is Wrong With HIT in the USA” PPT presentation on 12/2007 which I hope helped defund the Bush/Leavitt HIT tie-in to the bill that was to abolish the 10% physician pay cut.
2) In the www.sermo.com site there is a massive initiative to have most of the 30000 physicians sign a joint letter delineating our displeasure of the numerous developments that have adversely affected medical care- HIT being one of them.
3) In the Amazing Charts (AC) website forums, one of the largest threads is about CCHIT and P4P and how all its members detest the intrusion of these initiatives that may force these physicians to do away with their non-CCHIT certified EMR, some of which are completely paperless and totally pleased with the AC product.
4) At the www.emrupdate.com site there was a massive blow-out in December concerning the CCHIT, P4P, and e-prescribing initiatives.
People are fighting back. As per my personal Congressional insider, Bush’s plan is in jeopardy and they are ready to throw in the towel in July if they can’t get some sort of HIT bill finally ratified. What other lawmakers in Congress are finally noticing is that physicians are ready to opt out of Medicare altogether in droves and this may leave this important insurance plan that covers the elderly and sick poor populations in jeopardy.
It’s not for lack of a plan. It’s just that their plan is unpopular and is detested by all but the few lobbyists (particularly HIMSS), insurance company executives, and politicians who have a lot to gain by passage of HIT legislation.
Al Borges, M.D.
PPT presentation is at:
www.emrupdate.com/files/folders/al_borges/entry75428.aspx or at www.box.net/shared/static/mvwvacmck4.ppt
Throwing money to increase HIT interoperabilty and physician adoption of EMRs will not work if only because the big corporate interests, who are trying to protect expensive, proprietary systems, will drag it out with committee meetings and unworkable solutions. Temporizing solutions to achieve ‘interoperability’ like IHE are slow, expensive and favor the big players whose motives are more aligned with shareholder price appreciation than fixing the problem and opening themselves up to competition from less expensive (more affordable) solutions. It will take an Open Source solution that achieves some level of staying power to force everyone to play by the same rules. Medicapaedia is a proposed open source data model that will attempt to bridge the gap between disconnected, expensive proprietary systems and free or inexpensive HIT solutions. CCHIT is not the solution. While its original charter of defining a “minimum” set of features for a ‘valid’, certified EMR was noble, it has become a plaything for multiple stakeholders to asset their own pet interests - a so called “designed by committee” albatross that is creating bloated, sluiggish and unstable software. CCHIT must be pared back, or we will never achieve the promise of higher EMR adoption. Let a free market and competition decide the best products. Eventually a few clear leaders will emerge.
David Winn, M.D., FAAFP
Founder and CEO, e-MDs