The U.S. health care industry is undergoing several massive transformations, and the Office of the National Coordinator (ONC) for Health Information Technology in the Health and Human Services Dept. is spearheading the technical requirements and interpreting the legislative mandates into the specific policy requirements.
Its efforts started during the George W. Bush administration, which mandated in 2004 the use of interoperable electronic health records (EHR) systems by 2014 in what is known as the HITECH Act, and its efforts have become even more important due to the 2010 Patient Protection and Affordable Care Act (ACA), aka Obamacare, that changes the rules to ease citizens' access to medical care and to further require electronic systems use by providers and patients alike, so the use of such systems matters more in achieving the ACA's cost and eficiacy goals.
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Doug Fridsma, an M.D., is chief science officer and director of the ONC's Office of Science and Technology, and thus helps lead the federal efforts to make the HITECH requirements happen at a technical and medical level. Fridsma spent an hour with me discussing the issues that many health care IT and medical providers have raised as the deadlines get closer. The interview took place as the feds prepare to roll out the national signup registry this fall for individuals long denied health care to get it, though funds starvation by Republican congressmen has slowed the technical deployment and caused some rollout delays.
My key takeaway was not to think of the health IT efforts as the equivalent of ERP -- as I had been doing -- but as like the Internet. An ERP system prescribes process and procedure, whereas the Internet provides a framework for multiple kinds of uses and values. The feds want the latter, even if in the short term a single set of rules implemented via technology might have more appeal to health care providers that want a simple answer as to what they need to do. That's not an obvious approach in traditional IT thinking -- nor the approach used in many other countries -- but it makes a lot of sense given the constant change in technology.
The following is the edited transcript of our interview. Here are the key sections:
- Meaningful Use requirements: Why does it seem so hard?
- Health information exchanges: How to think about interoperability
- Patient engagement: Are portals too separate and locked down to gain adoption?
- How to keep sensitive information separate but accessible in a federated system
- Why incremental efforts are a better approach than a top-down specification
- Project Direct: A supplement to HIEs when pass-along makes sense
- Why health IT can't be like ERP or AOL: Avoiding the path of least regret