Q&A: Obama's Health IT Czar On Strategy, IncentivesQ&A: Obama's Health IT Czar On Strategy, Incentives

Dr. David Blumenthal -- a long-time Boston physician, official at Partners Healthcare System, and Harvard professor, was named national health IT coordinator to lead President Obama's health IT strategy in March.

Topping Blumenthal's list of duties is making recommendations to the U.S. Dept. of Health and Human Services about the fine details of the federal government's $20 billion-plus stimulus program aimed at incentivizing U.S. doctors and hospitals to use "qualified" electronic health systems in "meaningful" ways.

Blumenthal spoke Wednesday with information senior writer Marianne Kolbasuk McGee about progress being made on the mega-billion-dollar incentive program that launches in 2011.

information: You've said the final "meaningful use" definition isn't likely to be published until mid 2010. Is there any flexibility in adjusting the schedule of rewards in case healthcare providers can't accomplish everything they need to do to meet the "meaningful use" requirements? It seems like there won't be much time for providers to meet all requirements for the 2011 incentives once the meaningful use rule is published.

Blumenthal: The law is clear. It specifies how much money is available each year and for what. We will try our best to get this out as soon as possible. Once the proposed rule is public, I think providers will have some sense of direction. But for those who want to plan ahead, there will be some tea leaves to read.

information: Will the incentives be enough to get healthcare providers going to meet these requirements?

Blumenthal: I think there is a growing acceptance of the inevitability of electronic health systems to exchange information. No question the pace of adoption for meaningful use will increase at a steady pace over the next 5 or 10 years. The incentives will be sufficient to get most providers to adopt, and not sufficient for others. They will either move along at a slower pace or decide at some point that they don't have the wherewithal to do this. I suspect they will be minority -- small groups of physicians and hospitals that will continue to practice the way they always have.

information: You've said that you see these incentives programs as a "down payment" for larger national healthcare reform. Can you explain what you mean?

Blumenthal: It's a little like a preparatory phase, laying the groundwork, if you will, in a very literal way. If we want to improve quality and efficiency to ensure people get the kind of care they need rather than what we truly have, you need to undertake some kind of preparation. Part of that preparation is improving the capacity for managing information. Health IT is core to that. If healthcare reform gets passed, having invested in electronic health records before the bill was enacted and implemented will give us a head start.

information: You mentioned earlier this week (at a keynote speech at the HIT Symposium at MIT) that you wouldn't be surprised if some medical associations -- the boards that give certifications to medical specialists such as cardiologists, for example -- began making competency in the use of electronic health records or other health IT part of their certification requirements. Do you know of any such discussions going on? Blumenthal: I'm certain that will be true in the next decade or two, just because of the compelling logic to it. The tendency now for boards is to more and more certify physicians around their performance, rather around their testing results. I don't want to presume to know which boards will do what first, but I can tell you that the American Board of Pediatrics has already done this and the American Board of Internal Medicine has agreed to this in principle.

information: The Certification Commission for Health IT (CCHIT) recently announced additional "paths" for product certification so that more module software products will be eligible for certification, vs. just the larger, more comprehensive electronic health packages. So, when it comes to the incentive programs, can healthcare providers take a more modular approach? Meaning, will healthcare providers need to meet all the criteria for "meaningful use" to receive the incentives or will they be eligible for a percentage of the incentives, for say doing e-prescribing but not yet getting to some of the other requirements? In other words, are the incentives "all or nothing" or will they scale?

Blumenthal: This will be dealt with in the regulations that will be issued. I don't want to guess. More than that, I don't know what the law permits. General Counsel will have to help us interpret that.

information: In terms of hospitals and physicians eventually adhering to the "meaningful use" requirements, will there be some sort of mechanism that CMS [Centers of Medicare and Medicaid Services] will use to "prove" that healthcare providers are doing what they say they're doing with health IT? Is it a matter of good faith? Is it a matter of whether CMS gets certain data from healthcare providers, and so that must mean healthcare providers are doing what they're supposed to be doing with health IT? How subjective will all this be?

Blumenthal: That's another thing that will need to be determined in the process.

information: The stimulus legislation allocated $2 billion to the Office of National Coordinator of Health IT. Any specific programs for that yet?

Blumenthal: We have a number of programs on the drawing board that aren't public yet. Hope to become public over the summer. We're very much developing programs. Some are mandated by the legislation, such as $300 million appropriated for health information exchanges at the state level.

information: What about loan and grant programs?

Blumenthal: There is authority to make loans to states and tribes to facilitate the adoption and use of health IT.

information: Are these loans to state and tribes to start health data exchanges, or can they use the money for making their own loans and grants, like aiding healthcare organizations in rural communities to get going in health IT deployments?

Blumenthal: I can't answer that yet, we haven't gotten that far along.

information: There seems to be questions about whether CCHIT will remain the certification body for qualifying electronic medical records under the incentive programs. Is there potential for a new group to do this?

Blumenthal: We're looking at all our options right now and will make a decision in the near term. We'll ask the HIT Policy Committee to consider this issue and to make some recommendations.

information: In adopting electronic health records, it's hard for doctors, nurses and others in many organizations to change the way the work. But an even bigger challenge seems to be in getting competing healthcare organizations to [electronically] exchange information about patients. There's competitive uneasiness. Is that a relevant concern?

Blumenthal: Information exchange is a core for capability for an effective health system. Regardless of what doctors and hospitals want, patients clearly want their information to be able to travel in a secure and private way. So it's very much a goal of public policy to enhance information exchange. Hospitals are reluctant for the reasons you described…. The goal of our policies is to make it easy to exchange health information and to create a market for the exchange of information by giving hospitals and doctors incentives to be meaningful users, including the exchange of information as a key component.

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