Up at 5AM: The 5AM Solutions Blog

What the Nation's CTO says about Health-IT

Posted on Wed, Nov 04, 2009 @ 12:58 PM

Brent and I went to see our nation's CTO, Aneesh Chopra, speak today at a breakfast meeting held by the Northern Virginia Technical Council’s Health Technology Committee. He spoke about “health IT” and three tools he’s promoting to help us achieve better health care at lower costs. (I quote, and usually air-quote, “health IT” because I believe it’s a dangerously broad and overused term. Chopra had no qualms detailing that most “health IT” money is currently spent on two sides of the pay spectrum – systems, processes, and people to try to get money for healthcare, and systems, processes, and people to try to keep money from healthcare, which he succinctly described as new-world mutually assured destruction mentality. Definitely one definition of "health IT!")
  • Meaningful Use of electronic health record technology. The government is still working on its definition of meaningful use, which it will distribute at the end of the year. Many clinicians, care providers, and organizations are angling for a way to get in front of this definition so they can qualify for this designation (and attendant financial benefits), when it’s defined. I’m not going to spend time discussing the issue here (see this for more info), except to say that Chopra indicated that parts of it are staring to lean toward outcome-based definitions, rather that a checklist of compliance items, which is refreshing (although outcomes are a lot harder to define than checklist items, so this should be an interesting story to follow).
  • Standards. Chopra is chair of a newly-formed standards implementation group of the Health IT Standards Committee, so this issue is critical to him. He cites support of open standards, and is in the middle of a two-week period in which he’s actively seeking comments, inputs, and suggestions on what the committee should recommend regarding standards. Read it in his own words. As someone who has had to endure the hard work of standards adoption, I appreciate the freedom a term like “open standards” implies, but having achieved the benefits of the hard work of standards adoption, I also view such a term with skepticism and cynicism, because even though they're hard, standards work. I don’t want the government to shy away from defining standards for health information exchange. I don’t want us to wind up with a thousand silos that can’t communicate, enduring the expense and pain of n-factorial translation efforts. My fear is that “open” will lead to “tower of babel,” and I intend to comment and encourage others to as well.
  • NHIN (Nationwide Health Information Network). Since I’m working for the NHIN, I was very interested in what Chopra would have to say about it, and what the knowledge and reaction of the audience would be. The NHIN, which is a set of standards, protocols, and policies to allow the secure exchange of health information, is going live in January 2010, with government agencies such as the Social Security Administration, CDC, and the VA exchanging information with regional health information exchange organizations (aggregators of health provider data in states or regions), and delivery providers like Kaiser Permanente. The idea behind the NHIN is that Entity A can query the network about Patient Y, and receive information on that patient from those who have information. (Conceptually it supports the “let’s use the NHIN to see if anyone knows whether this unconscious patient in my ER is allergic to penicillin” scenario.) Chopra’s already envisioning the next version of the NHIN, which he describes as providing a full set of tools to allow individual doctor’s offices and patients using personally controlled health records (PCHRs) to participate. Having worked to get the “current” NHIN out into use, I welcome this expanded vision and look forward to the day when I can grab my lab results using my iPhone (might as well dream big...).
Since he was talking to interested innovators in the health IT space, Chopra laid out a world of opportunity that we can collectively create, where jobs are created (squads of geeks setting up EHR systems in doctor’s offices, systems and people to support online/automated follow-up care between hospitals and their patients), where competition drives new ideas, and where we all benefit from effective, efficient, technology-supported health care. He’s got an inspiring vision, an abundance mentality, and the means to inspire, drive, and support us as we start down the path. At founders of a company in business to see this vision achieved, Brent and I were happy for the reminder that with powerful leaders like Chopra, collaboration, creativity, and collective energy, we could actually get there.


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