Dr. David Blumenthal on life after ONC (podcast interview)

[audio http://healthbb.files.wordpress.com/2011/11/blumenthal2.mp3]
At the recent Partners Connected Health Symposium I sat down with Dr. David Blumenthal, former National Coordinator for Health Information Technology. We discussed the unfolding impact of his work on Meaningful Use, the role of the patient, health IT in the UK, and the future of health IT funding considering the partisan divide in Washington.

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DAVID WILLIAMS: This is David Williams, Co-founder of MedPharma Partners, and author of the Health Business Blog.

I'm at the 2011 Connected Health Symposium today. I'm speaking with Dr. David Blumenthal. He's Samuel O. Thier Professor of Medicine, Professor of Health Care Policy at Massachusetts General Hospital/ Partners Health Care System, and Harvard Medical School. He was also the National Coordinator of Health Information Technology until earlier this year. Dr. Blumenthal, thanks for being with me today.

DR. DAVID BLUMENTHAL: Thank you for having me.

WILLIAMS: I'd like to ask you a few questions about the unfolding impact of your work from ONC. Maybe the first question is about the patient's role in Meaningful Use. I think there's been a lot of emphasis, especially in the early stages, on physician and hospitals, but I know the patient is in there somewhere. I would love to get your views on where that comes in.

BLUMENTHAL: Well the law focused on the provider, and it was a logical place to focus. If you wanted to get the health care system digitized, most information is in the hands of providers at this point. That's also the group that can be influenced directly by public programs that pay for care.

When we have a substantial amount of information digitized, then I think the sharing of that information with patients becomes much more practical. The companies that are creating personal health records will actually have information that's ready to be deposited, and then it will be more meaningful to have patient engagement in a much more proactive way. In the transitional period, the Meaningful Use standard did require an unprecedented level of electronic sharing of information. And I suspect that the next version of Meaningful Use will move further along that trajectory.

So I think we are working toward patient engagement. That's one of the main aims of the meaningful use framework as it was initially proposed during the first phase of meaningful use. So I'm confident that it's well integrated into thinking about meaningful use. The Office of the National Coordinator has a consumer eHealth office, and is planning to give it a lot more emphasis going forward, as I think is appropriate.

WILLIAMS: Now, interoperability has always been a priority for you, but also an area where I know there are some challenges. I wonder if you could offer a perspective on where we are on interoperability today, and what the future looks like over whatever timeframe you think is reasonable.

BLUMENTHAL: Well, interoperability is an order of magnitude more difficult as a challenge than accomplishing the adoption of electronic health records. I think we are well on the way toward the adoption. We are at the beginning, I think, of the sigmoid acceleration of adoption that is classic for new technologies. I think it's already taken off for primary care. I think it's going to soon take off for hospitals.

I'm reasonably confident that we've turned a corner on the adoption. On exchange, the challenges are fundamentally more difficult. It is because it is a collaborative activity. It's not a individual activity. You have to have partners, and you have to work with partners, and you have to be willing to put the effort in to maintain those collaborations. That means there need to be incentives to do it, and rewards for doing it, and sustaining structures for doing it. Those social supports are much harder to develop than the technological supports.

So the Office of the National Coordinator's working really hard to increase the number and usefulness of standards. They will be promulgated and adopted, and they will be incorporated into electronic health records. I would say that over the next three to four years, I'm hoping, that the full suite of standards that we need to create an interoperable health system will be in place.

There will need to be, as a result, upgrading of current records and current technologies to accommodate those standards. Then the question will be will the provider community use them? That is, will they implement the capabilities to exchange information, and work with their partners, their collaborators, to overcome the inevitable kinks in the system. I think that will depend as much on the social and economic forces at work as it will on the technological progress we make.

WILLIAMS: Now certainly in the early years after the stimulus law was passed, there was a lot of focus on people chasing the incentives before they expire. But there's a penalty phase that comes in and I think does not expire. I'm wondering if you have a view on to what extent those penalties will actually motivate adoption, or the kind of behavioral change in that period that's upcoming only a few years from now.

BLUMENTHAL: The penalties will be very motivating for hospitals because there are substantial amounts of money. For individual physicians, I don't think they will be decisive. I think the individual physician will adopt ultimately because they view it as a requirement for modern practice. The money's nice, the penalty is something to be avoided. But it's really as much a signaling device as it is a real incentive.

The signal has now gone out loud and clear that the 21st century is the electronic age, and medicine can't isolate itself from the electronic age. Especially for young physicians, that needs no explanation or justification. For older physicians, that's where I think the money is a sweetener that will move them a little bit further than otherwise they would have gone.

WILLIAMS: With all be acrimony in Washington, it's pretty hard to find something that Democrats and Republicans agree on, and I think in health care in particular. Maybe one area might be some version of malpractice reform, although that has different flavors depending on where you're coming from. As far as I can tell, health IT is one of those areas where if there's not consensus, at least there's not so much rancor Democrat versus Republican. Do you have a sense of whether that is actually the case, and if so, why that might be?

BLUMENTHAL: I personally believe there's a great deal of bipartisan consensus in this area. There was danger of it being interrupted by the rancor around health reform in general. But my guess is that it will survive that test. My guess is that it will be one of the initiatives that the Congress will continue to support, maybe not as generously as it has in the past, but it will continue to support it.

People who really want to save money in health care are kind of forced into looking at information technology as a solution, and it's just so logical, so elementary, so clear and intuitive that it's needed. That almost anyone who's serious about deficit reduction, constraining the size of government, improving the function of a health care system, eventually comes around to saying IT is not enough, but it's really important.

WILLIAMS: I know you've closely watched the UK's progress on health information technology. I'm wondering if you can give me a sense of what they've accomplished there, and where they're heading in the UK.

BLUMENTHAL: Well the UK project is widely disparaged, and I think was not, perhaps, managed as well as it could have been. But we shouldn't forget that 100% of general practitioners in the UK have electronic health records. We shouldn't forget that they've used those records to dramatically improve compliance with quality metrics throughout their general practitioner sector. And that they have a very, very strong alliance between general practice and the EMR vendors in the UK such that, really, they are using their technology to advance health care goals and developing technology that can advance health care goals.

Where they fell short was in this effort to incorporate the hospitals into the electronic system. And they fell short, I think, because they treated it as a procurement project, rather than as a social change and behavior change project. That's a very common and damaging mistake to make.

The spine they've created, the separate communication technology that they put in place, may turn out to be a great gift to their system. I think the verdict is still out on that. And they have made progress. So I wouldn't discount the fact that they will be moving forward rapidly. But they made some tactical errors in implementing the system as it was conceived.

WILLIAMS: Well, we're at the Connected Health Symposium here in Boston, and I know that you participated today on a futurist panel. I'm wondering if there are any key take-aways that came out of that session.

BLUMENTHAL: I thought the panel we had showed a wide range of views and concerns. Maybe the major message was that IT is in the eye of the beholder. There are so many specific technologies and specific uses of those technologies that are encompassed under the term health information technology that it's easy for people to sit next to each other on a podium and talk about rather different phenomena, and rather different technical needs, and very different care needs, and rather different policies.

So on the one hand you had a company like Verizon, which is trying to think about the use of wireless and cloud-based technologies for enhancing the sharing of information, and runs this huge communication network worldwide. A great resource, a very important company to be involved. On the other hand, you had a geneticist and computer scientist who is thinking about using networking theory to build more complete views of genetic, and physical, and population explanations of diseases. And I was talking about how the 2012 election is going to affect our efforts to create a health information network.

So I think it was indicative of the widespread ferment, and creative ferment, in this field. It's a very hopeful time. A very dynamic time. It's almost like the clam shell has opened in health care, and suddenly we are beginning to experience the world that has existed around us for several decades, and it's going to shake things up and stir things around. And that's all to the good. It's just going to be a lot for the average doctor to digest.

WILLIAMS: I've been speaking today with Dr. David Blumenthal, formerly National Coordinator of Health Information Technology. Very interested to hear what you're going to be up to next. I'm looking forward to when you can make that announcement. Meanwhile, thanks for your time today.

BLUMENTHAL: Thank you. Good luck to you.