Blumenthal: Meaningful Use, healthcare reform 'two sides of the same coin'

Image removed.National health IT coordinator Dr. David Blumenthal welcomed providers and health IT vendors alike into the "era of meaningful use" at last week's eHealth Initiative Annual Conference held in Washington, D.C. In his speech to attendees, he talked about the importance of organizing locally, but standardizing nationally, calling it a task unlike any other. "There is no more challenging work for us than exchange," Blumenthal said.

FierceEMR caught up with Blumenthal after the conference to chat even more about the ONC's efforts, and how healthcare reform will affect those efforts.

FEMR: At eHealth, you talked about how other nations (in Europe) have struggled with similar efforts to push interoperability. Given that they've been at it longer--and they're smaller--what makes you optimistic interoperability can be successful here?

Blumenthal: A lot of European countries focused almost exclusively on adopting electronic health records for many years. It was true in the UK, it was true in Holland, it was true in Sweden. They got to virtually 100 percent adoption of their electronic health records among, especially, general practitioners. They didn't particularly plan for interoperability at the time adoption occurred. That meant that they had often many vendors selling into the market without standardized vocabularies or content or transport.

I think we have the opportunity to build interoperability into the adoption process in a way that they didn't. They're trying to retrofit interoperability into--and often at the cost of having to change--the software that's already been adopted by virtually 100 percent of their physicians. That's an expensive and demanding thing to do. So I think that's one of the big disadvantages that they have.

For example, in Holland, they've had to get agreement from general practitioners to modify their electronic health records in order to create interoperability. To get agreement on the standards, after the standards have been adopted, is much harder than to do it in advance the way we're trying to do it. 

Now having said that, I still don't think it's going to be easy. 

FEMR: What do you tell a doctor who runs a small clinic in a small town, who seemingly has no incentive to comply with Meaningful Use--and may, in fact, be de-incentivized by the overall ratio of cost to reimbursement--to try to convince him that Meaningful Use is worthwhile? What is your pitch? 

Blumenthal: Well, I would start by saying that if they ever plan to adopt electronic health records, they have a once-in-a-lifetime chance to get substantial government support and help with it--and that's now. Later on, they will have to do without those financial incentives. So that's one of the gambles that they take.

If they are younger, I would say to them that it's impossible to imagine they will complete their career without making the transition to an electronic health record. We are a digital society and the idea that a huge industry that occupies 17 percent of our GDP--with most of that allocation being controlled by physicians and hospitals--that they should remain a kind of walled-off medieval city of paper record keeping and information management, I think it's inconceivable. I actually think that most younger physicians who see that they'll be practicing for 20 or more years get that, and I think they will accept the inevitability...they're just trying to figure out the timing. I think the timing is, right now there's an opportunity, and it won't come again.

For older physicians, I think it's going to be almost impossible for them to replace themselves unless they have an information system that a younger physician can work with. Or, they'll have to discount the price of the practice, accordingly, because the younger physician will say 'I don't want this practice unless I can install an electronic health record.' It's a little bit like re-doing the roof, if you're buying a house: You give me a roof that leaks, I'm going to take that out of the purchase price. So I think there's another economic rationale.

Ultimately, though, I think physicians are going to end up doing this because they think it's right. I think the money will be helpful, the economics...the incentives work. But many more will do it because they just can't practice with pride unless they are modern and up to date and meet the standards of their peers.

FEMR: Even though the Meaningful Use push stems from the American Recovery and Reinvestment Act (and not the Affordable Care Act, as some mistakenly continue to believe), what sorts of effects do you anticipate reform having on Meaningful Use efforts now and going forward?

Blumenthal: I think meaningful use and health information technology are critical to delivery system reform and vice-versa. I was a hospital vice president for four years, and I worked in a big hospital system. There is no way to change the behavior of a big organization without information, so just imagine if you tell GE to cut the cost of production of its jet engines, but you say 'Oh, and by the way, you can't use computers.' They'd look at you like you had just parachuted in from Mars.

And exactly the same problem and challenge occurs in a hospital that wants to cut the price of caring for a coronary bypass graft or a knee replacement or pneumonia chaser. You need to know where the money is spent, and where the flaws in the process are, and then you need to feed back data to your employees and your staff. And if you don't give them that, they don't know whether they're successful. They don't know if the changes they've made are working.

To collect all that data with a pen and paper, it's a medieval approach. It's like going back to 1950. So, I don't see how we can accomplish all the cost controls that every politician and every manager should want without Health IT. 

On the other hand, getting the doctor in that small clinic to adopt is a lot easier if he or she can participate in the savings that occur when Health IT is adopted. Right now our payment system doesn't allow that. So we need new payment systems. And we also need accountability--shared accountability--because many people manage complex chronic illness. And unless they are jointly accountable, it's very hard to get a good product at a good cost. So creating the accountability mechanisms is vital to getting people to adopt the systems they need to ensure accountability.

So I think I see them as two sides of the same coin. We won't be happy fully with the results of health information technology unless we harness it to delivery system change, and vice-versa. 

FEMR: Given how fast the technology landscape shifts (almost on a daily basis), do you see these Meaningful Use stages as more of a continuous process? Something that, as technology evolves, so, too, will the regulations?

Blumenthal: I think Congress did not specify a deadline or an end to the creation of the Meaningful Use rule, and I think that was wise. We will need to play that by ear. We did create stages, in part, for the reason you outline. Some people said at the time we were writing Stage 1 regulation, 'just tell us where you want us to be in 2018, and then leave us alone and let us get there.' And our response was, 'we can't tell you what you'll be capable of in 2018, and we certainly don't want to fix that in regulation, and place a ceiling on what you are capable of. We want you to adopt this technology and make the best of it, and change with it and grow with it.'

In some ways, the most powerful thing we can do, as I've said many times, is to get people on the escalator toward increasingly sophisticated and beneficial uses of electronic health records. And I do believe that once our nation's health professionals experience the power of electronic health records, they will become a source of innovation and demand for ever-improving functionality, for improving usability, for improving capability--and that will be a very powerful force for change. 

FEMR: Clearly, you're a Red Sox fan, with the Fenway Park references you made in your eHealth Initiative speech. With Boston going out and getting not one, but two big splash players this offseason in Adrian Gonzalez and Carl Crawford, but not really addressing any pitching needs, what do you think their chances are of making it back to the World Series? 

Blumenthal: Oh gosh. You know, I'd rather try to write another Meaningful Use regulation than predict what will happen with the Red Sox. I live about three miles from Fenway Park. As a matter of fact, I have to drive by it before I go to work. So I'm very mixed about the start of the baseball season. It's always a great source of optimism in April, but then I also think 'how am I going to get home?'

I think the Red Sox have a quality organization, just like the Patriots, and I think they have a good chance at the pennant. We just need to get them more money to compete with the Yankees.

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