This week, the well regarded periodical, Health Affairs published its annual issue that focuses on Healthcare IT (HIT). One of the papers published was authored by ONC, with ONC head, Dr. David Blumenthal listed as a co-author. The paper, The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results (think they could have made the title any longer?) ultimately took a close look at 154 studies conducted between July 2007 and February 2010 on the impact of HIT on a number of critical factors including quality and efficiency of care delivered and physician satisfaction.
There has been more than a few questions raised over the last couple of years as to the actual contribution HIT provides and whether or not we are on the right track with the substantial investment this country is making via incentives, grants and various programs to encourage the adoption and use of HIT among physicians and hospitals. Adding to those questions is the current fiscal crisis that this country and virtually all States are facing leading one to wonder, is this the best use of the taxpayers’ precious dollars. It appears that ONC’s sponsorship of this exhaustive study, which as the title states found overall positive contributions of HIT adoption, is an attempt to put those arguments to rest. It sure seems that way to this analyst as there was an unprecedented amount of “media push” coming out of ONC to get the story out including granting exclusive interviews for which Chilmark took advantage of yesterday in a ~15 minute interview with Blumenthal.
Prior to the interview, ONC requested the list of questions I would ask of Dr. Blumenthal. Thinking that 15 minutes was precious little time, I developed three questions that were open ended, but also did not tread into waters which I knew were verboten, e.g. what will be in Stage 2 MU… The three questions and paraphrased responses based on my notes are provided below:
1) Many of the negative findings appear to involve challenges in adopting CPOE and workflow redesign. How will these findings/revelations influence future policy within ONC and more broadly across HHS?
Blumenthal: We always knew there would be challenges in adoption of HIT and for CPOE we significantly lowered the threshold in Stage One MU requirements. I can not speak to future MU requirements but do believe we are on the right track and it is important to remember that the intent of this law is not for everyone to meet MU requirements.
2) If indeed the “human element” is critical to successful HIT adoption, how will HHS seek to improve that metric in the adoption process?
Blumenthal: This is where the Regional Extension Centers (RECs) will play an important role in the future. RECs will be sharing best practices across the country amongst one another to insure that the human element in the adoption of HIT is minimized. Also, over time as more systems are installed, greater adoption occurs and physicians become more comfortable with their use we will see the human element become less of an issue.
3) What did you personally find as the most interesting/insightful finding of this publication review exercise?
Blumenthal: I was pleasantly surprised that the literature review supported positive outcomes as the result of the adoption of HIT across so many dimensions, particularly gains in efficiency.
Going through those questions actually went more quickly than I expected so I tossed in one more:
4) Usability of HIT solutions (EHR) remains an issue and Chuck Friedman of your office presented at HIMSS’11 that ONC, along with NIST were going to dig deeper into this issue. What will be ONC’s role?
Blumenthal: The challenge of usability is very real. I have head from many physicians, ‘I wish the computer worked for me and I didn’t work for the computer.’ Oftentimes, physicians do not do enough due diligence before buying a solution and do not know fully what they are getting until it is fully installed. EHRs are also very complicated products so determining what one might end up with is not always readily apparent in an initial review of a product. We hope to shed some sunshine on true usability. ONC itself will not ultimately be doing the testing, we will look to others (editor’s note: he’s likely certifying bodies such as CCHIT, Drummond, Surescripts, etc.).
In closing, I have a ton of respect for Dr. Blumenthal. The job he was given when he joined HHS two years ago was monumental. He has put in a Herculean effort to bring us to where we are today and I hope, I pray, that his successor will be able to carry the baton forward with such skill.