HIMSS: ONC exec calls for input, outlines its challenges
ATLANTA--David Hunt, MD, chief medical officer and acting director of the Office of the National Coordinator for Health IT (ONC), described the work ahead for his agency. “At ONC, 2010 is a bit of a moment. It’s incredibly exciting and more than a little bit scary,” Hunt conveyed during the opening keynote of the Physicians IT Symposium today at HIMSS10.

“The tacit assumption about the ONC is it’s about technology, that our work is health IT. A more appropriate way to describe our mandate is that the ONC has been given unprecedented resources and authority to effect an improvement in healthcare through meaningful use of health IT,” he said.

“Our resources are profound, but they are far short of the inertia we are attempting to overcome,” he said. However, by leveraging the power of technology and meaningful use of healthcare information, Hunt said the U.S. can surmount the inertia and change the culture of patient care.

“This moment in time, perhaps more than any other, is the time for clinical leadership. We must be the first to acknowledge that the success of our effort will require a team effort," he said. “The path forward requires a system, tremendous resources and no small amount of courage.”

“All will not be made right if we just make Silicon valley the epicenter of American medicine. The value of each technological advance can only be measured against the scale of one patient at a time. In the end, the healing art trumps science,” said Hunt. “The point is not to have the latest technology. The infrastructure is the means to the end or it is nothing at all.”

We see our job defined by HITECH as defining what meaningful use of electronic health records is, then support the medical community in meeting that definition," Hunt said, " We will establish public trust in a healthcare system that more effectively uses this technology. Finally, we will foster greater innovation in health IT."

He acknowledged the challenges that ONC faces in getting EMRs into all healthcare settings. Only 6.3 percent of physicians use EHRs, he said. “Physicians are not the business hicks that some people believe. [Low] EHR market share is a reflection of significant barriers. For many, EHR [deployment] has not been worth it. [Practitioners] have made a clear statement to embrace EHRs, as our needs must be met.”

Improving the quality of care is the single greatest contribution that physicians can bring to the movement of healthcare reform, and ONC is working to increase efficiency and transparency of healthcare and increasing the capacity to study and improve healthcare delivery, according to Hunt. But “we’re not so naive to believe that any or all of these goals can be solved with an EHR alone," he said. “But if we look at what can be done through the lens and the help of an EHR, the path is clearly through meaningful use of this tool.”

“We desperately need to review all comments,” said Hunt. “We need your help, because no country has implemented what we are trying to do.” In speaking about the Obama administration's desire for accountability and transparency, he said that recovery act dollars are like "dollars with radioactive tags: ONC wants to track them and get the most value out of every one spent."

“Our lot cannot be improved by technology alone, but technology can be a lever to exchange information," Hunt said. "The whole point is to provide the means to facilitate communication and the transfer of information—and possibly, even the transfer of knowledge.”

Questions & Answers:
Hunt ended his presentation by answering audience questions, which are paraphrased below:
Q: With regard to e-prescribing, the current proposed denominator is problematic, because e-prescribing is not an option in many areas. Will CMS consider changing it?
Hunt: The lack of area pharmacies that accept e-prescribing will be taken into account. You can still print out prescriptions if no pharmacy can accept e-prescribing. We recognize the need for broadband.

Q: According to CMS' pediatrician requirements, to be an eligible practitioner, 20 percent of patient encounters must be attributable to Medicaid, which is not realistic for many providers because of geographic location, reimbursement rates, etc. Providers might already be using an EMR, but why bother to seek meaningful use if they won’t qualify?
Hunt: This is the time to tell Congress if something is not working. We have to work within the legislative framework and do what Congress says. We have no way to sidestep legislative measures.

Q: Having separate processes for controlled and uncontrolled substances (per Drug Enforcement Agency requirements) will not work.
Hunt: Physicians won’t e-prescribe because of this, and we need to hear from you to make a recommendation for changes. Hopefully, market forces will eventually help us develop a better system.

Q: When will CMS recognize physicians’ use of health IT beyond EMRs?
Hunt: Congress told us to concentrate on EMRs; we need to get a critical mass for EMRs first. However, we have awarded SHARP grants for non-EMR health IT initiatives.

Q: Some vendors have good EMR systems, and some don’t. What are you doing to deal with the issue of obsolescence in EMR technology?
Hunt: We’re working on guidelines and best practices to find out what works. We also established the HIT Resource Center, an umbrella organization to coordinate information from regional health centers. Contact your regional health center and also send me a note.