Blumenthal's departure will not derail federal health IT

Dr. David Blumenthal, who announced late last week that he's leaving his post as National Coordinator for Health IT in the spring, is proud of his accomplishments--as evidenced by his departing memo to staff members--and continues to be the chief defender of the health information technology faith.

Both of those facets were on display at the recent press conference announcing the Direct Project, a secure messaging protocol designed to help healthcare providers exchange clinical data. At the end of Blumenthal's remarks, he unexpectedly rattled off a series of milestones that the Office of the National Coordinator of Health IT (ONC) has achieved: 14,000 providers registered for meaningful use incentives in the first month of eligibility; 40,000 physicians enrolled in the regional extension centers that are helping small practices choose and implement EHRs; thousands of new health IT technicians graduating from federally sponsored community college programs; and the dispensing of grants to state health information exchanges and "Beacon Communities" in the vanguard of health IT.

When a questioner asked Blumenthal about a recent Stanford study purportedly showing that EHRs don't improve the quality of care, the ONC chief quickly rose to the challenge, citing problems with the study's methodology and calling for the U.S. to catch up to other advanced nations that have universally adopted EHRs.

If Blumenthal is so focused on spreading the health IT gospel, why, then, is he quitting? Some observers wonder whether his stated reason--to return to Harvard University within the 2-year period needed to retain his tenure--is his real motivation, considering that the government EHR incentive program is now entering its most critical phase.

Evan Steele, president and CEO of SRS Software and author of the EMR Straight Talk blog, writes that he finds the timing of Blumenthal's departure odd. "Why is Blumenthal stepping down now, when the program is at such a critical juncture?" he asks. Also, he wonders, "Why is [Department of Health and Human Services] Secretary [Kathleen] Sebelius just now 'conducting a national search for the right successor' even though she reports that it was always the plan that Dr. Blumenthal would end his term at this point?"

Others view Blumenthal's exit as a temporary setback for the government program. Dr. William Bria, chief medical information officer at Shriners Hospital for Children in Tampa and president of the Association of Medical Directors and Information Systems (AMDIS), notes that some recent developments have been "nibbling at the edges" of the government's health IT drive. These include the White House's recent PCAST report, which is critical of certain aspects of the ONC program; the recently introduced House legislation (H.R. 408) that could rescind funding for the health IT incentives; and general complaints about the meaningful use criteria, including grumblings from hospital executives that it will be costly and difficult for them to meet the requirements.

Bria doesn't believe, however, that Blumenthal's departure will derail the meaningful use initiative. He instead asserts that the ONC chief "has built enough of a team and enough of a get this done.

"I think America is on a threshold of a major transformation of improving its healthcare environment," he said.

I agree. The PCAST report soon will be a footnote. H.R. 408 will go nowhere. And the kvetching of hospital execs about the difficulty of implementing CPOE eventually will die down as they get with the program. But Blumenthal's contribution to translating the Administration's lofty goals into a concrete program for increasing EHR adoption and interoperability will last.

As for Blumenthal's motives, let's just remember what a hard job he has. David Brailer, the first health IT czar, stayed on for only two years--the same amount of time as Blumenthal. And while Robert Kolodner, the second ONC chief, lasted a bit longer, he did much less than Blumenthal has because the Bush Administration never got Congress to provide significant health IT funding.

So farewell, David Blumenthal. I just hope your successor has as much drive and vision as you do. He or she is going to need it. - Ken

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