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March 01, 2009

Slouching towards HITECH Act implementation

I attended the Transforming Healthcare Summit in Boston last Thursday evening, saw a bunch of old friends and met some new ones.  About 500 people turned out for the event.  It featured a keynote by Jim Roosevelt, CEO of Tufts Health Plan.  He was excited about the comparative effectiveness provision of the HITECH Act, preventive care advances, and the opportunity to translate some lessons from the Massachusetts experience with universal health care coverage to the national arena. Jim's talk highlighted four key issues that he believes are the central issues of the health care system that we all need to grapple with (not that they are immediately soluble problems, but they demand our engagement):

1.  Ensure quality and effectiveness of heath care services, which may be facilitated by broader HIT adoption, chronic disease management programs, P4P programs, prevention and wellness programs.

2.  Reverse the growing shortage of PCPs

3.  Improve transparency of health care cost and quality.

4.  Address racial and income disparities.

Aspirational goals, and a tall order, to be sure.  Jim comes by such goals honestly; as his introduction noted, he is FDR's grandson.

These opening remarks were followed by a panel discussion moderated by Scott Kirsner, blogger and columnist at the Boston Globe.  The panel included Roosevelt, Charlie Baker, blogger and CEO of Harvard Pilgrim Health Care, John Glaser, occasional blogger and CIO of Partners Healthcare, and Jonathan Bush, CEO of athenahealth.  It was a freewheeling discussion punctuated by a bunch of good-natured ribbing among the panelists (especially once it was established that Roosevelt was the only Democrat on the panel, and the suggestion was made that the three other panelists were perhaps the only Republicans in Massachusetts). 

The meeting was serendipitously scheduled just after the signing of the stimulus package, including the HITECH Act (starts on p. 112 of the stimulus package, or ARRA), which provided much fodder for the evening's discussants.  It was a lively conversation, but perhaps a bit too soon after the signing, as there are still some significant open questions regarding implementation.

Two important examples:

  • What does "meaningful use" of EHRs mean?  Providers engaged in "meaningful use" of EHRs are eligible for the stimulus incentive payments.  The term will have to be defined in regulations. John Glaser expressed the hope that "meaningful use" is defined so as to include a requirement of communicating aggregated patient data to enable further development of evidence-based medicine, one of the key justifications that has been offered for computerizing medical records.

  • What will the new EHR certification body look like, and what EHR certification standards will be used?  Many observers are concerned that CCHIT will, by default or inertia, end up ensconced in this position, using existing standards.  John Halamka, who has a bit of an inside track on this sort of thing, expects that "NeHC will become the standards committee and will create value cases that contain standards and architecture for HITSP to harmonize and CCHIT to certify."  Read his whole post.

To get more of a sense of the evening, and to see an archived "live-tweeted" event, check out the consolidated twitterstream of everyone who tweeted the event.  If that's too overwhelming, take a look at just the HealthBlawger's twitterstream.  The links go to the oldest page of each twitterstream; read up, and page back to the newer pages to read in order.

Finally, for some "CEO on the street" sound bites collected after the panel discussion, check out the one-minute interviews with several health care CEOs in the audience, at David Williams' Health Business Blog.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

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