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Blumenthal: Building national health network could take decades

Despite many barriers, the national health network envisioned by former ONC head Dr. David Blumenthal will be built, he says -- but maybe not by the HITECH Act's goal of 2015.

WORCESTER, Mass. -- When Dr. David Blumenthal was national health IT coordinator, he focused on 2015, the HITECH Act's original target date for meeting meaningful use criteria. Now that he's back in civilian life, he's taking a longer view of the initiative to create a national health network triggered by the HITECH Act's cash incentives to physicians and hospitals using electronic health record (EHR) systems.

Blumenthal, who keynoted the Massachusetts annual health IT conference last week, quoted President Barack Obama's line that the HITECH Act was a "down payment" on health reform. He likened the fusion of health IT and payment reform processes -- in the spirit of reducing health care costs while making quality gains -- to a series of mountains to climb, one peak after another.

"It won't be about technology, but about the goals that the technology serves," Blumenthal said of health IT enabling health care reform in his address. Building a secure, national, interoperable health information system "was always going to be a multi-year, maybe even multi-decade project. We got off to a very promising start when the [HITECH] law was passed, because the law was very clear that the aspiration was about health care change and not the technology."

Post-ONC, Blumenthal still HITECH Act champion

Even though Blumenthal is back in the private sector as a health policy professor at Harvard School of Public Health after resigning his federal post earlier this year, he told his message hasn't changed much.

I don't think there's an objective database that gives you a valid, reliable assessment of performance of different vendors.
Dr. David Blumenthalprofessor of health policy, Harvard School of Public Health

"Obviously, I can say whatever I want, in a sense -- I'm not accountable to the [Obama] administration," Blumenthal said. "But a lot of the decisions that [ONC] made I was involved in, so I still support them. I felt we had a lot of support to do what was essentially the right thing."

Sometimes, in question-and-answer exchanges after addresses at health IT conferences last year, it might have seemed to audience members like Blumenthal was holding back -- or choosing words cautiously. He sometimes didn't speak frankly, he said, "because we were in a regulatory process, and I couldn't -- as a matter of law -- talk about what we were doing. I also held back talking about vendors because I didn't think I knew, well enough, about the comparative strengths and weaknesses of different vendors. I still don't think I know; I don't think there's an objective database that gives you a valid, reliable assessment of performance of different vendors."

Blumenthal said in his keynote at the Massachusetts conference that, as of May 9, a "great majority" of the software vendors that appear on the certified health IT product list have fewer than 50 employees. One of these "garage level" companies, he predicted, will be the dominant software in future years, crediting the meaningful use framework-- including its EHR certification process -- for driving this phenomenon.

After his keynote, he told SearchHealthIT those vendors are significant because smaller companies traditionally drive innovation in health IT and biotechnology. "Big companies, with a few exceptions -- Apple is one, Google is another -- innovate by acquiring the ideas of small companies," Blumenthal said. He said he hopes such innovation will make EHR systems easier to use and also less expensive.

EHR adoption easy; national health network, not so much

U.S. EHR adoption is a "solvable problem," Blumenthal said in his keynote, pointing out that other countries have attained nearly 100% provider EHR adoption, and that graduating nurses and physicians in U.S. universities are now well-versed in using electronic charts. With more than 36,000 physicians having applied for meaningful use money so far, and 10,000 more doing so each month, the former HIT coordinator predicted that EHR saturation will come to the health care system.

On the other hand, building a national health information network is a much more difficult proposition. Citing an international survey conducted by the University of British Columbia, Blumenthal said that the largest health information exchange built to date, public or private, supports 9 million patients.

"This wasn't the equivalent of Moore's Law for the health information technology system," Blumenthal said, "but it was an interesting observation pointing to the importance of local solutions to health information exchange, the importance of trust, and the importance of scale in creating effective exchange."

Successfully building a national health network will be like winning a football game, Blumenthal said. No matter the skill of the quarterback, the de facto leader of the team, he still needs teammates who are committed to the cause:

Getting past barriers of scale, he concluded, requires health IT leaders to achieve system interoperability and also gain public trust that health records will remain secure.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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