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Mostashari named new national HIT coordinator

Farzad Mostashari

Farzad Mostashari, M.D. has been named the new national coordinator for health IT, effective today. Though HHS has not put out a press release or other statement, it appears this is a permanent rather than an interim appointment. I had been hearing since February that Mostashari, who previously was deputy national coordinator, would be in charge of ONC at least on an interim basis when David Blumenthal, M.D., returned to Harvard.

UPDATE, 3:25 p.m. CDT: The appointment is permanent. You can find this and more details in the story I wrote for InformationWeek today.

April 8, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

ONC opens comments on federal HIT strategic plan

The Office of the National Coordinator for Health Information Technology today opened a four-week comment period on proposed revisions to the Federal Health IT Strategic Plan (pdf). Last updated in 2008, the plan spells out ONC’s strategy for meeting national health IT goals for the five-year period beginning in 2011. The HITECH Act requires this revision.

According to a blog post by national coordinator Dr. David Blumenthal:

Some components of the Plan may already be familiar, including the Medicare and Medicaid Electronic Health Record Incentive Programs and the grant programs created by the HITECH Act, which are creating an infrastructure to support meaningful use. However, the Plan also charts new ground for the federal health IT agenda:

  • In Goal I, the health information exchange strategy focuses on first fostering business models that create health information exchange, supporting exchange where it is not taking place, and ensuring that information exchange takes place across different business models.
  • In Goal II, we discuss how integral health IT is to the National Health Care Quality Strategy and Plan that is required by the Affordable Care Act.
  • In Goal III, we highlight efforts to step up protections to improve privacy and security of health information, and discuss a major investment in an education and outreach strategy to increase the provider community and the public’s understanding of electronic health information, how their information can be used, and their privacy and security rights under the HIPAA Privacy and Security rules.
  • In Goal IV, we recognize the importance of empowering individuals with access to their electronic health information through useful tools that can be a powerful driver in moving toward more patient-centered care.
  • In Goal V, we have developed a path forward for building a “learning health system,” that can aggregate, analyze, and leverage health information to improve knowledge about health care across populations.

ONC is accepting comments through April 22 via the blog site.


March 25, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Poll for new national coordinator is rather laughable

Leave it to those in the ivory tower of Modern Healthcare to screw up something as simple as an unscientific poll about who should be the next national coordinator for health IT.  The poll lists a whopping two dozen names, ranging from the obvious—Dr. John Halamka, Dr. Paul Tang, current deputy national coordinator Dr. Farzad Mostashari—to the dark horse—Dr. Robert Hitchcock of T-System, Paula Gregory of the “Philadelphia College of Osteopathic Medicince” (sic)—and even a few laughable listings.

For one thing, Dr. David Brailer is on the list. The first national coordinator (2004-06) left Washington because he wanted to be with his family in San Francisco. He’s currently running a $700 million equity investment firm and couldn’t possibly want to get back into the political game, could he? Besides, he’s a Republican. Dr. William Hersh, CMIO of Oregon Health and Science University, would make a good choice, but he’s already said he doesn’t want the job.

Another choice is current CMS Adminstrator Dr. Donald Berwick. Dirty politics is about to force him out, and if that happens, you can bet he won’t want to be within 400 miles of Washington. (Hey, that just happens to be the distance to his home in the Boston area.) I’m really steamed about the Berwick situation, and am preparing  a separate post that hopefully will go up tomorrow.

Modern Healthcare also includes Janet Marchibroda, who’s identified as chief healthcare officer of IBM. Sorry, but Marchibroda, former CEO of the eHealth Initiative, left IBM last year. My sources tell me she’s now working at ONC, serving as de facto chief of staff to current coordinator Dr. David Blumenthal. (Blumenthal, as you no doubt know, is leaving in April.)

Missing from the long list of names is Johns Hopkins CIO Stephanie Reel, who won in a landslide the equally informal, unscientific poll that HIStalk ran a couple weeks ago. HIStalk did report, though, that Allscripts effectively stuffed the ballot box. Also not included is Blumenthal’s predecessor, Dr. Robert Kolodner, but he doesn’t want to go back, either.

I’m not going to run another survey here (hey, I doubt I have the readership to make it worthwhile anyway), but I’m curious if people think a non-physician could or should be national coordinator.

March 10, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

March ‘Health Affairs’ out tomorrow with health IT studies

The policy journal Health Affairs has just put out a media advisory noting that the March issue, which comes out tomorrow, will have at least three articles devoted to health IT. From the advisory (verbatim):

Studies on EHR:

  • Neil Fleming and colleagues shed light on the financial and nonfinancial resources a small practice needs to implement an EHR system. Using data from  a physician network in north Texas, the authors estimate that the average cost to implement EHRs is $46,659 per physician.
  • Use of EHRs will be accelerated because more than four in five office-based doctors are eligible for federal “meaningful use” incentives, says Brian Bruen of George Washington University and colleagues. Their analysis also highlights gaps in eligibility that must be addressed to further increase the adoption of EHRs, including variations by specialty, size and type of practice, and location.

A paper from the Office of the National Coordinator for Health Information Technology (ONC) on the benefits of health IT:

  • 92% of recent articles on health IT have reached positive conclusions, report Melina Beeuwkes Buntin, David Blumenthal and colleagues. In their literature review, they found that papers that assessed provider or staff satisfaction were less likely to report positive outcomes than those that did not.

The embargo on the stories lifts just after midnight Eastern time.

March 7, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blumenthal will return to Harvard in April

According to former U.S. Sen. Dave Durenberger (R-Minn.), national health IT coordinator Dr. David Blumenthal will return to Harvard in April, and Blumenthal, as has been widely rumored, is leaving to keep his tenure.

So far, Blumenthal and HHS have been saying he would leave his current post at an unspecified point in the spring. But, as Durenberger writes in his weekly commentary about health policy, “David told me he was planning an April return to Harvard when his two year leave to serve the new administration is up. … David’s departure to keep his tenure at Harvard apparently came as a surprise in D.C. where he’d become widely respected for aligning the Office of National Coordinator with the ‘meaningful use’ of health IT.”

Durenberger also notes that Blumenthal is the brother of Sen. Richard Blumenthal (D-Conn.). I wondered if there was a relation. Now I know.

Durenberger chairs the National Institute of Health Policy and serves as a senior health policy fellow at the University of St. Thomas in Minneapolis.

February 14, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blumenthal talks e-prescribing

As you may have already heard, Surescripts today gave its annual update of progress in e-prescribing. About one-third of office-based clinicians now write at least some prescriptions electronically and the overall e-prescribing rate is up to 12 percent.

Surescripts had a transcription service present and provided these remarks from featured speaker Dr. David Blumenthal:

Well, thank you, Mr. [Harry] Totonis [president and CEO of Surescripts]. I appreciate your kind words. And it’s a pleasure to be here. It’s a pleasure to be part of the recognition of these ten states, who are pioneering and meeting on a very important contribution to the health and welfare of Americans.

As I go down the list, I can’t help noticing that my home State of Massachusetts is at the top.

And I want you to know that until 17 months ago, I was a proud electronic prescriber in Massachusetts contributing to that first place finish.

I’m sorry Senator Reed has left because I would have noted that Rhode Island, though it has a lot to teach the rest of the country, also has a lot to learn from Massachusetts.

I also notice that I have visited five of those ten states in the last three months. I hope to get to the rest of them before I run out of steam. I also note that six of them had been recipients of our Beacon [Communities] Award Program, which is a way of saying that e-prescribing is a gateway into success along a whole range of electronic and health care performances because our Beacon Program really was about health care improvement through electronic systems, rather than about electronic systems.

Though the senators have left, I can’t help noting that Senator Whitehouse was indeed a terrific champion for the legislation that created my office. It is to him that I owe the privilege of serving in this role because he and his colleagues equipped it with such important tools to move the needle on adoption and meaningful use of electronic health information systems in the United States.

And he I know was a leader in Rhode Island as well through the Rhode Island Quality Institute, which has provided an example on many levels to other communities that have sought to emulate their work on e prescribing and electronic exchange of information.

I find his notion of enjoyment a little bit paradoxical. I’m sure for those of us sitting under that scrutiny, it’s a little less enjoyable. But I do look forward at some point to having the opportunity to experience Senator Whitehouse’s prosecutorial skills (Laughter.) at the other side of that exchange.

I also want to congratulate Surescripts and Harry Totonis for their leadership. It is the private sector that is moving this work forward. The federal government is a catalyst. We can help correct market failures. We can help make the playing field more hospitable for the private sector. But it is thousands upon thousands of providers and thousands of companies and community leaders, insurance companies, and businesses outside of the health sector who are making it possible for communities to lift themselves up on every dimension of health care, not just on health information technology, though that is, we believe, obviously a foundational element.

To argue that there are 200,000 physicians e-prescribing is really reassuring. We, however, have a long way to go. Two hundred thousand is probably about a third of the practicing physicians in the United States. And it’s that two thirds that we are concerned about and making sure that they have the tools, incentives, the rewards for becoming e-prescribers in the very near future.

We know that there are important gains from e-prescribing. I know there are important gains. I have spoken in the past of my own personal use of the electronic health record, of the experience that I had using an e-prescribing capability through computerized provider order entry, in which the drug allergy checks that are brought to bear by e-prescribing prevented me from prescribing medication to which a patient was allergic. And I know that that kind of feedback in real time at the point of decision is only possible through order entry and e-prescribing with the drug-drug interaction and drug allergy checks that are possible to add on to the e-prescribing and computerized provider order entry functionalities.

We did some work in my own research group at the Mass General Hospital before I left documenting the cost reductions associated with electronic prescribing. So I know and have seen through my own group’s work the potential impact in well done scientific studies of electronic prescribing in terms of moving from brand to generic medications.

And also I saw in my own e-prescribing the way in which it enabled me to prescribe drugs that were on a patient’s formulary in which I could check the cost of the medication in real time looking at all of the options available for that class of medication and picking not only the one that was covered by that patient’s insurance but the least expensive one covered by that patient insurance. That would be hours of work without the electronic prescribing capability.

The states which are recognized here, of course, are recognized for the work of their clinicians in prescribing, but we also know at the Office of the National Coordinator that states have a very important leadership role.

We have given over $560 million to the 56 states and territories to encourage them to play a leadership role to build in their state government or in related entities that they have chosen the capacity to provide leadership for health information technology in their states. And one of the things that we have prioritized is creating e-prescribing as a leading effort at information exchange.

And we have also, of course, included e-prescribing in many ways within the Meaningful Use framework. And I should give credit to my colleagues at the Centers for Medicare and Medicaid Services who have actually lead responsibility for that Meaningful Use framework, but our Policy Committee, the [Health IT] Policy Committee for the Office of the National Coordinator, was also extremely helpful and highlighted four functionalities in Meaningful Use that relate to e-prescribing or support it; first of all, the maintenance of an active medication list; secondly, directly the generation and transmission of permissible prescriptions electronically; thirdly, the implementation of drug formulary checks; and, fourthly, the performance of medication reconciliation between care settings.

The latter two were in the menu set, the menu set, from which you could pick five. But we have suggested in that regulation that some of these menu set, actually, all of these menu set functionalities would be part of the required set for stage 2 of Meaningful Use.

Of course, e-prescribing under the influence of the Health HITECH Act was one of the required functionalities for Meaningful Use. So I can’t claim that we dreamed this up entirely. But we do see that it is one of the ways in which Meaningful Use will create value for the American people.
A lot has been done, but an enormous amount remains to be done in our work and in the work of the recipients of these awards and throughout the offices and around the nurses’ stations of America’s physicians and hospitals.

We are looking forward and beginning, actually, to some early reconnaissance around the development of our next phase of Meaningful Use, Meaningful Use stage 2. Our Health Information Technology Policy Committee met to discuss that just about ten days ago.

We, of course, want to learn before we jump into stage 2 of Meaningful Use how things have gone in stage 1, but we also know that there was a set of unfinished tasks and things that we passed over in the effort to get the first Meaningful Use stage, the first stage of Meaningful Use, out the door in a timely way.

There are two areas that I think really deserve much more attention in the second stage of Meaningful Use. And one of them is the area of health information exchange. The first stage of Meaningful Use set the groundwork technically for health information exchange but didn’t complete that task and didn’t require really robust exchange on the part of potential recipients of incentive payments.

So I think that the provider community and the vendor community should look forward to a much more robust set of requirements around health information exchange, an exchange that consciously transcends, ignores economic relationships, institutional relationships, and geographic relationships, and political jurisdictions. Again, we want information to follow patients.
The second thing that we hinted at but did not push very hard in the first stage of Meaningful Use was the second functionality, the second type of capability that adds so much value to the electronic health record. And that is clinical decision support.

I can tell you that as a user of electronic health record, I valued the availability of information that it made possible, not having to look through those paper charts anymore and knowing that I could find the old radiology reports without scrambling through a folder or ordering up a record from Stone Mountain, which would never be there anyway in time for my patient visit, but even more I valued the way it made me, the way clinical decision support made me a better doctor, the way in which it made my decisions better, the way it made them more scientific, more consistent with the patients’ needs.

And those are the things that I think will really sell the health care industry on this technology, not the recording, the physical recording, of information electronically but the ability to be better at what you do as a result of a technology that supports you in your role as a professional.
If you’re a nurse or a doctor or a respiratory therapist or a laboratory technician, having that reinforcement, that instruction, that access to new scientific information is really what makes the provider go home with a smile on his face or her face.

We are also going to be working to improve quality metrics contained in the Meaningful Use framework and to make sure that those are electronically compatible and take advantage of the electronic capabilities of records. And we have an enormous amount to do in terms of implementing the large array of programs that we have started: our Beacon Community grants; our regional extension centers, which are there to make physicians able to become meaningful users; our state grants to health information exchanges; our training, our effort to train, over 40,000 new health information technology workers, giving them good jobs with a future in an economic sector that is exploding and will continue to explode throughout our lifetimes; and our research work through our strategic health IT advanced research programs, one of which focuses on enhancing the exchange of health information.

So we have an enormous remaining set of tasks, but it has been a privilege to be here over the last 17 months or so and watch the federal government and the private sector and the state government sector come together to set the groundwork for this, set the foundation for this revolution in health information management.

And I again want to congratulate both the states, the congressional delegations, and Surescripts for their role in making all of this possible. Thanks again.

September 21, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Extormity throws down

I just received the following e-mail from Extormity:

Electronic health records vendor Extormity, dismayed at the ambitious scope of ARRA meaningful use criteria, is challenging National Coordinator for Health Information Technology David Blumenthal to a “rumble.”

“This call for physical confrontation is an extension of our ‘Whine into Water’ lobbying initiative, where we have joined with other large and inflexible EMR vendors to raise concerns about the difficulty of achieving meaningful use as currently defined,” said Extormity CEO Brantley Whittington. “If enough of us bellyache about these aggressive criteria, we are hoping they will be watered down such that meaningful use is effectively rendered meaningless.”

“However, in the event our campaign is unsuccessful, I would like to engage David Blumenthal in hand-to-hand combat at an upcoming HIT conference,” added Whittington. “Can you imagine what a mano y mano cage match would do for HIMSS attendance? I’m not proposing actual fisticuffs, rather, I suggest we thumb wrestle — best two out of three and the victor gets to set final meaningful use criteria.”

While other EMR vendors are refraining from public comment, an officer at another large HIT organization expressed tacit approval. Speaking on condition of anonymity, this executive was supportive of Extormity’s efforts. “Current criteria will reward nimble, flexible, innovative vendors who are focused on affordable, interoperable, web-based solutions designed to improve patient care. We question the audacity of the government in setting criteria designed to improve clinical outcomes and reduce costs — this callous irresponsibility will punish those of us with expensive client-server solutions that require physicians to abandon established workflows as they implement our hard-to-use applications. The trickle down effect would have a disastrous impact on our economy — if our profits fall, our lavish executive bonuses will be eviscerated and we will have less to spend in the Hamptons.”

Asked if Mr. Blumenthal should be concerned about a potential threat to his physical safety, Whittington was nonplussed. “Since Extormity is a fictional organization developed as a parody of lumbering, expensive and ineffective EHR vendors, and I don’t actually exist, there is no actual hazard. With that said, I know jujitsu.”

I’m not aware of a response by Blumenthal.

December 15, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

A first from ONC

Perhaps it’s part of the Obama administration’s new PR offensive on health reform, or perhaps he just wants to update the health IT community, but National Health IT Coordinator Dr. David Blumenthal has sent out an open letter to everyone on the Office of the National Coordinator for Health Information Technology‘s mailing list.

Here’s what he says:

In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.

In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.

But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.

Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.

The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.

We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.

In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.


David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

August 19, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

ONC to meet with potential CCHIT alternatives

SEATTLE—Here’s a juicy rumor from the first day of the sixth annual Healthcare Unbound conference: the Office of the National Coordinator for Health Information Technology is planning a July meeting with several people considering starting up certification bodies to compete with the Certification Commission for Healthcare Information Technology.

I say it’s a rumor because I haven’t been able to confirm this information yet. It does make plenty of sense, though. ONC head Dr. David Blumenthal wrote in the New England Journal of Medicine back in March that “many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”

This does not mean that CCHIT will get frozen out of the certification process, just that it shouldn’t come as a surprise if the federal government recognizes more than one certifying entity.

June 22, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blumenthal named national coordinator

Well, Robert Kolodner, M.D., won’t be keeping his job as national coordinator for health IT after all. That’s because the Obama administration today named Harvard University medical informaticist David Blumenthal, M.D., to lead the Office of the National Coordinator for Health Information Technology.

Blumenthal, director of the Institute for Health Policy at Partners HealthCare System in Boston, was a senior advisor to Barack Obama during the presidential campaign and years ago was an aide to Sen. Edward M. Kennedy (D-Mass.), so this sounds like a clear political move. Kolodner was a career professional at the Department of Veterans Affairs prior to taking over at ONC in 2006, and Healthcare IT News reports that he likely will be going back to the VA.

March 20, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.