Blumenthal Has Good Grasp of Health IT Situation
The recent appointment of David Blumenthal, MD, as National Coordinator of Health Information Technology bodes well for the government's effort to gain widespread adoption of electronic health records by physicians and hospitals. Most recently the director of the Institute for Health Policy at Massachusetts General Hospital, as well as a Harvard Medical School professor, Blumenthal has written extensively about health IT and has participated in several studies that measured the extent to which these systems are being used in U.S. health care. Most important, he understands the practical obstacles to the use of information technology for improving the quality of care. As the superintendent of an office that now has $2 billion at its disposal, his grasp of the field could prove crucial in moving it forward.
In 2007, Blumenthal and John Glaser, the CIO of Partners Healthcare and a health IT pioneer, coauthored an article that appeared in The New England Journal of Medicine under the title, "Information Technology Comes To Medicine." They pointed out that advocates of the technology "view the adoption of HIT as the opening wedge into, indeed a fundamental catalyst of, widespread change in the practice of medicine."
To use EHRs for this purpose, however, physicians will have to modify everything they do, from how they make medical decisions to how they document patient encounters to how they interact with colleagues and patients. So the technology that's supposed to catalyze change requires physicians to change first. But why should they do that? Widespread EMR adoption, Blumenthal and Glaser note, will require the creation of an environment "in which doctors and hospitals find quality improvement and cost reduction essential to accomplishing their financial and professional goals."
While some studies have shown that the use of EHRs can positively affect quality and efficiency, Blumenthal and Glaser pointed out these studies were mostly done in academic medical centers that had developed their own EHRs. Thus their relevance to most doctors and hospitals is uncertain. Moreover, they noted, commercial products must be designed to help physicians achieve these goals in order to transform healthcare. "The HIT products now being sold are intended to meet the present needs of clinicians," not the future needs that reformers envision.
In a new NEJM article, Blumenthal observes that some certified EHRs of the type that physicians would have to use to qualify for government incentives "are neither user-friendly nor designed to meet [the federal] HITECH [Act]'s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for [the Office of the National Coordinator of Health Information Technology]."
Blumenthal acknowledges that ONCHIT will have some other challenges, starting with the relatively brief amount of time allowed for putting the HITECH Act into effect. "The infrastructure to support HIT adoption should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses," he points out.
He also observes that "if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively." So qualified products will have to include decision support features. But he warns that if the bar is set too high, "many physicians and hospitals may rebel--petitioning Congress to change the law or just resigning themselves to forgoing incentives and accepting penalties."
Taken together, all of these statements indicate that Blumenthal understands what this momentous policy change entails for health care. He doesn't have all the answers, but at least he asks the right questions.