Follow-up from HIMSS

This year's Healthcare Information Management and Systems Society (HIMSS) Annual Conference in Orlando, Florida was interesting and enjoyable as always. Clearly the focus was on healthcare organizations and vendors achieving meaningful use of electronic health records (EHRs) . However, there was also plenty of other buzz on topics such as health information exchange, the impact of the departure of Dr. Blumenthal, and changes going on in Washington, DC.

There was also, of course, much talk about health IT workforce issues and the ONC Workforce Development Program. I was video-interviewed on aspects of the topic by:

• Joseph Conn of Modern Healthcare, who produced a six and a half minute video on workforce issues and educational programs
• Mary Stevens of CMIO Magazine, who produced a three and a half minute video on education and career opportunities for physicians, especially those aspire to be CMIOs.

Accolades for the Informatics Professor and His Blog

I have had the opportunity to publish and speak in some high-profile venues lately, and my blog and my book have received some honors. For the sake of the reader, however, I will roll all of my "bragging" into just this single post.

Let me start with publishing, where I have been invited to make some commentaries on various aspects of informatics. One of these was a contribution to a series of commentaries on the HITECH program in the prestigious journal Nature. (Subscription required for HTML and PDF versions.)

Another was an invitation to write an editorial accompanying a study on the development of registries in chronic kidney disease in the journal, Clinical Journal of the American Society for Nephrology (subscription required).

I have also be invited to talk on panels at a couple of high-profile meetings. One talk was on a panel at the AcademyHealth National Health Policy Conference (February 7-8, Washington, DC). The panel was focused on workforce issues, with speakers addressing different aspects of the healthcare workforce issue. Naturally I was invited to speak on informatics issues, describing the ONC Health IT Workforce Program as well as informatics competencies for modern healthcare professionals (slides).

Another talk is on a panel at this week's HIMSS Annual Conference on the ONC Health IT Workforce Program. I will speak about the Health IT Curriculum Development Centers Program (slides). OHSU serves not only as one of the five Curriculum Development Centers but also the National Training & Dissemination Center tasked with disseminating the curricular materials via a Web site and training community college faculty in their use.

I am also pleased to report that the Informatics Professor blog has been recognized by three sites that rate blogs:

• Top Professors of Math & Science Blogs
• Forty-Six Health Care Blogs for Professionals
• 50 Resources for Students Attending Online Health Information Schools

Finally, I am honored to have my book reviewed by one of my favorite blogs, Keith Boone's Healthcare Standards blog. It turns out that Keith did some work in search earlier in his career and has some poignant things to say about my book (and my blog). I look forward to his book on Clinical Document Architecture due out this spring.

Welcome to Oregon, President Obama and Mr. Otellini

Today I will have the opportunity to attend President Obama's visit to Intel Corp. in Portland, Oregon. While I will just be among the crowd, I would love the opportunity to talk with both of them, and will post my comments of what I would say in this blog entry.

President Obama, I want to thank you for the opportunity afforded by the HITECH Act in your stimulus legislation. I wish we could have you over to visit Oregon Health & Science University (OHSU), where we have put the $5.8 million awarded to us under the HITECH Act to good use. It is an investment in human capital that is building the workforce of future professionals who will lead the "meaningful use" of electronic health records (EHRs) to improve the quality and safety of healthcare. On time and on budget, we are not only one of nine universities training these professionals from around the country, but also one of five universities developing curricular materials for shorter-term community college programs. In the latter program, we also serve as the National Training & Development Center, training and supporting community college faculty in use of the materials and disseminating them via a secure Web site. We have also enhanced the scope of the program by building a curriculum around the VistA EHR system from the Veteran's Administration. This system is another exemplary federal project that has drastically improved healthcare delivery by the VA, and now will provide additional value in training future health information technology professionals in using and configuring EHRs.

To Intel Corp., namely Mr. Paul Otellini, CEO, I would love the opportunity to show off the work being done by a local university, OHSU, in your company's own backyard here in Oregon. I would relish the opportunity to work with your company more to increase economic development and create high-skill, high-paying jobs in Oregon. I have written in this blog, a local tech blog, and even our local newspaper, the Oregonian, about the potential that exists in Oregon for synergy among companies, an innovative healthcare system, and a world class academic program in biomedical informatics at OHSU to create an economic cluster around health information technology. Investing in students, research, and companies could pay off well for our region.

Postscript: I had an enjoyable time visiting Intel and hearing President Obama speak. I managed to get a front row seat and was able to shake the President's hand afterwards. Of course I took pictures and posted some of them on Facebook. I still would love the opportunity to address either the President or Mr. Otellini about the issues raised above.

HITECH: Improving Healthcare Through Data and Action

Every now and then, I am asked to give an overview of the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA, also known as the “economic stimulus bill”). The centerpiece of HITECH is a plan to vastly expand the adoption and “meaningful use” of electronic health records (EHRs) [1], based on a growing body of research demonstrating that EHRs, especially when combined with clinical decision support (CDS), can improve the quality, safety, and coordination of healthcare [2, 3]. Similar to other areas related to technology and/or healthcare, the US has become a laggard in the adoption of EHRs, falling behind most other developed countries [4].

HITECH provides up to $27 billion for eligible professionals and hospitals to receive incentives for achieving the meaningful use of EHRs [5]. Meaningful use is a critical concept. The goal of HITECH is not just to put computers into physician offices and on hospital wards, but rather to use them toward five goals for the US healthcare system: improve quality, safety and efficiency; engage patients in their care; increase coordination of care; improve the health status of the population; and ensure privacy and security. As such, every criterion in meaningful use (e.g., drug-drug interaction checking) must tie back to a healthcare goal (e.g., improve quality, safety and efficiency).

Government funds for HITECH incentives will be distributed through the public Medicare and Medicaid reimbursement systems. Depending on choice of funding through Medicare or Medicaid, eligible professionals can receive $44,000-$63,000, while eligible hospitals can receive $2-9 million between 2011 and 2018. The main purpose of these incentive funds is to cover the costs of investment in EHR systems. It is anticipated that further costs will become part of the "costs of doing business" for healthcare.

The HITECH legislation recognizes that incentives alone will not be enough to achieve all the goals of meaningful use. As such, HITECH allocates an additional $2 billion for various human and organizational infrastructure elements to attain its mandates. A critical portion of this infrastructure is the ability to achieve health information exchange (HIE), which is the secure flow of data to wherever it is needed for patient care, including across traditional business and other boundaries in the healthcare system [6]. About $547 million is allocated to states for HIE development.

Another critical piece of the infrastructure is the provision of technical support to achieve meaningful use. This is done with the allocation of about $677 million to 62 regional extension centers that are providing a variety of forms of assistance, mainly to small primary care practices [7].

An additional portion of the required infrastructure is a competent professional workforce to develop, implement, and train users of EHR and related systems. It has been estimated that the HITECH agenda will require an additional 50,000 professionals trained in fields such as biomedical informatics and health information management [8]. About $118 million has been allocated for both short-term training programs in community colleges as well as longer programs mostly at the graduate level in universities. My institution, Oregon Health & Science Univeristy, is playing a major role in this program.

The HITECH legislation also recognizes that additional research and development is required. As such, $60 million has been allocated to establish four collaborative research centers focusing on the topics of security and health information technology, patient-centered cognitive support, health care application and network design, and secondary use of EHR information. A related funding initiative is the Beacon Communities Program, which has funded about $250 million for 17 advanced demonstration projects “shine the light” forward.

Just as meaningful use connotes that EHR adoption is not just about installing computer technology in clinical settings, there are related initiatives in the United States that will synergize with the substantial HITECH investment. One initiative from the Institute of Medicine aims to develop the “learning health care system” that learns from the growing volume of captured data what does and does not work in healthcare [9]. This is closely related to the growing push for “comparative effectiveness research” that aims to compare tests, treatments, and other medical activities in head-to-head studies carried out in real-world settings [10]. This infrastructure will also likely contribute to the growing push for translational research, as exemplified by funding for the Clinical & Translational Science Award (CTSA) program of the National Institutes of Health [11].

Taken collectively, all these programs from HITECH to ACA, the learning healthcare system, and CTSA provide a vision of a new healthcare system that learns from its successes and changes based on its mistakes. This vision uses data as the critical enabler of coordinating, measuring, and researching care. HITECH is indeed a grand experiment, and it is likely be that some elements of this experiment will succeed whereas others fail. But in the end, the healthcare system should benefit this unprecedented investment in information systems, human capital, and goals for improving health.

References

1. Blumenthal D, Launching HITECH. New England Journal of Medicine, 2010. 362: 382-385.
2. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 2005. 293: 1223-1238.
3. Goldzweig CL, Towfigh A, Maglione M, and Shekelle PG, Costs and benefits of health information technology: new trends from the literature. Health Affairs, 2009. 28: w282-w293.
4. Schoen C, Osborn R, Doty MM, Squires D, Peugh J, and Applebaum S, A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs, 2009. 28: w1171-1183.
5. Blumenthal D and Tavenner M, The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 2010. 363: 501-504.
6. Vest JR and Gamm LD, Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association, 2010. 17: 288-294.
7. Maxson E, Jain S, Kendall M, Mostashari F, and Blumenthal D, The regional extension center program: helping physicians meaningfully use health information technology. Annals of Internal Medicine, 2010. 153: 666-670.
8. Hersh W, The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics, 2010. 1: 197-212.
9. Eden J, Wheatley B, McNeil B, and Sox H, eds. Knowing What Works in Health Care: A Roadmap for the Nation. 2008, National Academies Press: Washington, DC.
10. Murray RK and McElwee NE, Comparative effectiveness research: critically intertwined with health care reform and the future of biomedical innovation. Archives of Internal Medicine, 2010. 170: 596-599.
11. Zerhouni EA, Translational research: moving discovery to practice. Clinical Pharmacology and Therapeutics, 2007. 81: 126-128.