ONC town hall meeting shows progress, frustration
Dr. Robert Kolodner, interim national coordinator and the leadership team from the Office of the National Coordinator for Health Information Technology (ONCHIT) moderated a town hall meeting yesterday at HIMSS 2007 in New Orleans. Kolodner and a panel of ONCHIT department directors were very upbeat, but some comments and questions from some of the town hall participants were definitely not all happiness and light.

Kolodner opened his remarks as sort of a state of the union for health IT initiatives in this country. He said that former National Coordinator Dr. David J. Brailer had gotten the initiatives going at a pace of accomplishments that is maintainable, and that he did a good job of bringing together many disparate systems and players.

Beyond this and from his perspective, Kolodner believes that all of us, regardless of our perspective, should understand that we are all consumers of the same healthcare system. He encouraged the town hall attendees to consider the question, “what quality and value of healthcare services do you demand?”

And he reiterated his belief that “health IT is not about technology, it is about improving the quality of care and of health.”

“Privacy, security, and confidentiality” are the underlying background behind all of the other efforts that ONCHIT is focused on, he said, which seemed to ruffle some feathers in the audience – those who think that ONCHIT efforts have not done enough in the area.

He closed his opening remarks by declaring the major elements of the work they are doing which are: governance, policy, technology, and adoption. “These are not silos, they do overlap,” he said.

ONCHIT is at work on a variety initiatives focused on privacy, patient-centric data flow, widespread adoption of interoperable health IT, how to get RHIOs over the financial hump to make money and path to financial sustainability, new telemedicine licensing alternatives to provide electronic care across state boundaries that fall within state labs and address medical liability, and the eventual transition of the American Health Information Community (AHIC) to the private sector. They have been successful in changing CLIA regulations to allow appropriate sharing of lab results among healthcare professionals.

Following a few more presentations, a question and answer period began.

One participant pointedly asked Kolodner whether the Bush administration’s goal of broad EHR adoption in 10 years is still a realistic goal. Kolodner responded that absolutely it is realistic and most Americans will have these types of records in the original time frame. Moreover, most Americans also will have access to PHRs (personal health records). PHR adoption might spur EHR adoption on some level, he said, but regardless the pace that they are currently going will see that goal met.

Another participant raised the issue of medically underserved communities, and questioned how their needs will be met. One of the directors accompanying Kolodner stated that it is hoped that the advancement of the NHIN (National Healthcare Information Network) would hopefully act as a great equalizer and bring more health IT access and improved care to underserved communities.

The issue was then brought up about there being too many variables between rules (privacy and otherwise) from state to state. A couple of the panel members from ONC chimed in that numerous efforts underway will be a big help. Though it won’t be over night, there is a lot of work being put into it, they said. Specifically, efforts from the HITSP (Health Information Technology Standards Panel) should bring some resolution to the problem.

A somewhat aggravated participant put it to the panel that privacy and security had not been enough of an emphasis, and not enough work has been done with HITSP towards this goal. “HITSP has not been precluded from focusing on privacy and security,” said Kolodner. The organization has been waiting on the results form their initial work to see new possible areas of focus regarding privacy and security, and it will take up the issue further in 2007, another panel member said.

However, the attendee loudly disputed the claim that privacy has been a focus area, and like many things, it has been an “afterthought.” Kolodner responded that “privacy and security is not an afterthought” and it is vital to the work that they are doing.

Yet another participant questioned why imaging has not yet been a major focus of federal health record standards. To this Kolodner responded that “we have a limited budget and time and we end up prioritizing.” AHIC (American Health Information Community) has not yet set this as a priority, and the way to get things done is to have a number of commissioners on your side, he said.
This puzzled the attendee because images have standards, images have “digital originals” so why has this not been a part of the electronic health record standard? Koloder tried to explain the complexities involved in getting something like this rolling, which includes getting the ear of AHIC commissioners so the issue gets on the table as part of the agency.

The attendee said that in the face of the difficulty of having an impact on the AHIC agenda that what is needed is a type of roadmap or process in place so that that agenda can be more easily shaped by interested members of the healthcare community.

For more information, visit: hhs.gov/healthit.