8/3/2019 David Blumenthal
1/3The Business of Goverwww.businessofgovernment.org2 0
Profiles in Leadership
Dr. David Blumenthalational Coordinator, Health nformation
TechnologyU.S. Department of Health and Human Services
By Michael J. K
Implementing the National Health Information Technology
Agenda
The U.S. healthcare system has a history of innovation
marked
by the ability to translate basic research into new clinical
and
therapeutic approaches that sustain human life and health.Such
success brings with it significant challenges. Healthcare
costs continue to rise at rates higher than inflation while
producing a system mired with inconsistent quality and ever
expanding access pressures. Against this backdrop, the
nstitute
of Medicine has concluded that the American healthcare
system
is in need of fundamental change, noting that healthcare
today
harms too frequently and fails to deliver its potential
benefits.
n the 21st century, for two and a half trillion dollars,
think
we can do better, declares Dr. David Blumenthal, national
coordinator for Health nformation Technology (HT) within
the U.S. Department of Health and Human Services (HHS).
Dr. Blumenthal leads the office charged with implement-ing a
nationwide, interoperable, privacy-protected health
information technology infrastructure. The Office of ational
Coordinator for Health T (OC) was created in 2004 by
Executive Order [13335], explains Blumenthal. t was ini-
tially mandated to provide a coordinating function across
the
federal government in helping to organize health information
technology activities. Blumenthal acknowledges that at its
inception the office was fairly small with limited
resources,
but with a uniquely important mission. Health information
technology, explains Blumenthal, is just a way of collecting
and moving a patients health information. ts what think of
as the circulatory system. f you think of information as
thelifeblood of medicine, then health information technology is
its heart and arteries. And youre, as a physician, only as
good
as your circulatory system.
Many believe that health information technology or health T
has the potential to transform the practice of healthcare by
reducing costs and improving quality. While health T offers
much promise, there is a need for leadership, coordinat
action, infrastructure and incentives, and common agre
for its promise to become reality.
The passage of the Health nformation Technology for
Economic and Clinical Health Act of 2009 (the HTECH
as part of the American ecovery and einvestment Act
2009 (AA) seeks to transform the promise of health T
a healthcare system built for the 21st century. t instanti
the office in law, providing the national coordinator wit
more resources, clearer authorities, and many time-sens
requirements. This has required us to look at the office
and re-create it as a locus of action and leadership, ass
Blumenthal, for a very ambitious project, ambitious by
governmental or non-governmental standard. The HTE
Act allocated $2 billion directly for his office to do justthis
and lay the groundwork for the accelerating the ado
tion and meaningful use of health T nationwide. To ta
country that extends from the Bering Strait to Key West
as diverse as this country with the variation in its health
s
from rural Montana to downtown Chicago is a tremend
project of social change, acknowledges Blumenthal.
Serious barriers to the adoption and use of health T, sp
cally an electronic health record (EH), continue to exi
The barriers are pretty well defined, explains Blument
The first is money. The second is technical and psycho
calfears that providers have of buying the wrong techogy or not
being able to implement it. The third is a lac
of a workforce to support the implementation of health
information technology. Blumenthal has begun to tack
many of these issues by using the funding and authority
afforded his office under HTECH. This has involved wo
with the Centers for Medicare and Medicare Services (C
along with the HT olicy and the HT Standards commi
8/3/2019 David Blumenthal
3/3The Business of Goverwww.businessofgovernment.org2 2
n the end, the purpose of this initiative is to improve
health
and improve efficiency, not simply to install technology.
to establish a regulatory regime that defines meaningful use
as well as set standards and certification criteria for
health
information systems. The core and most powerful element of
the HTECH Act is the concept of meaningful use. Two rela-
tively simple words, but very powerful when applied as the
Act states they should be, declares Blumenthal. According to
Blumenthal, no other country has ever, in regulatory form
with
such precision and completeness stated, in effect, this is
what
we expect of the most modern health information systems.
This is what we expect people to do with it; this is what
weexpect it to be able to produce, and this is what we think is
valuable about it, valuable enough that well pay extra for
it.
For instance, starting in 2011, physicians who demonstrate
that
they are meaningful users of certified electronic health
records
(EHs) can receive extra Medicare payments. These payments
could total $44,000 in additional funds over a five year
period.
There are a host of additional financial incentives for such
institutions as hospitals. Along with these carrots, there are
a
few sticks. By 2015, physicians who are not meaningful users
of EHs will lose 1 percent of their Medicare fees, which
will
increase by an additional 1 percent for each year
thereafter.
n tandem with financial incentives, Dr. Blumenthal has
established grant programs charged with helping provid-
ers adopt and becoming meaningful users of EHs. Were
setting up egional Extension Centers, which are going to
be community-based organizations that are available to
help doctors get online and use the equipment. Were tar-
geting small primary care practices in underserved areas.
Extension centers will offer technical assistance, guidance,
and information on best practices to support and accelerate
healthcare providers efforts. OC has also allocated funds
for workforce training, assisting educational institutions
to
expand health informatics education programs. Blumenthal
notes that this training will emphasis more than just the
attributes of specific technologies that workers may need;
it
will also school them in quality improvement and process
redesign techniques. n the end, the purpose of this
initiative
is to improve health and improve efficiency, not simply to
install technology. rants have also gone to states and com-
munities to support the creation of viable health
information
exchanges, as well as to establish beacon communities
will use funds to build and strengthen their health T inf
structure and exchange capabilities to demonstrate the v
of meaningful health T.
n our broad authority, notes Blumenthal, we had the
opportunity to single out some areas for intensive short-
long-term research. Weve put $60 million into what we
the Strategic Health T Advanced esearch rojects (SH
rogram. These efforts will seek improvements in the qity,
safety, and efficiency of healthcare, through advance
information technology. n April 2010, OC awarded fo
cooperative agreements totaling $60 million ($15 millio
each) to various institutions. Each institution will implem
a research program addressing a specific research focus
security, patient-centered cognitive support, healthcare ap
tion and network architectures, or secondary use of EH
m not a technical person, explains Blumenthal. th
some ways thats been an advantage. dont get particu
involved in the technology. m here because care abo
reforming the health system and helping patients. usedelectronic
health record for a decade as a physician, so
know what its like to use it. can speak credibly and w
authority about an electronic health record. ve seen it
me a better doctor. can tell very specific stories about
sions it has improved, care it has improved, and money
saved for me as an individual physician.
To hear The Business of Government Hours interview with
Dr. David Blumenthal, go to the Centers website at
www.businessofgovernment.org.
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To read the full transcript ofThe Business of Government
Hour
interview with Dr. David Blumenthal, visit the Centers
website
www.businessofgovernment.org.
To learn more about the Office of the ational Coordinator for
Hea
nformation Technology, go to www.healthit.hhs.gov
