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Blumenthal Predicts Eventual Peace with Hospitals on Health IT Issue

By John Reichard, CQ Healthbeat Editor

April 26, 2010 -- The American Hospital Association may be blasting ads urging him to scale back a proposed "meaningful use" standard for Medicare payments for health information technology, but that didn't stop health IT czar David Blumenthal Monday from predicting a partnership between hospitals and the federal government on the issue.

Speaking to the AHA annual meeting, Blumenthal, the national coordinator for health information technology, said "it is of course possible that no one will be completely happy with the outcome of the debate. But we're also confident that when the dust settles that we can go on to work together as partners toward what I think we share as common objectives – which is an understanding that without electronic information we cannot be as good as we all aspire to be. "

AHA has been beaming ads at Congress saying that at least 275 members of Congress have questioned the proposed meaningful use criteria and urging that the Centers for Medicare and Medicaid Services take a more incremental approach. The proposal calls on hospitals to fulfill 23 criteria to qualify for higher federal payments as meaningful users of IT.

There's little reason to expect CMS won't back off at least somewhat. That is often the case when it makes demands on industry that could easily be overridden by lawmakers who often as not are friendly to provider interests.

With the rulemaking process underway, Blumenthal wasn't talking specifics about the meaningful use standard but addressed other issues, such as a change in thinking regarding the creation of a national data network.

He said that in the past his office "has focused on a relatively sophisticated prototype. . .which would realize in a full way our aspirations." The vision has been of a system that would "make it possible in our imagination to find out everything we need to know about a patient who showed up without an electronic health record in one of our emergency department or in our outpatient facilities.

"That level of sophistication is desirable but may not be achievable by everyone and all institutions and practices who participate in the exchange," he said. As a result, "we've begun developing a more straightforward, less demanding form of health information exchange" called National Health Information Network – Direct. NHIN-Direct will try to put in electronic form the kind of exchange that's been common in the paper-based health care system – the physician to physician, hospital to physician, and physician to hospital exchange of data. The goal is to take those communication channels and put them on the Internet.

Blumenthal also said he would announce "very soon" the communities the Department of Health and Human Services will give grants to as part of its "Beacon" program. The program "will fund 15 communities to try to realize very explicit community-wide goals for health improvement and efficiency improvement using health information technology. We hope these communities will in fact be beacons to guide other communities," he said.

But speakers on the panel on which Blumenthal appeared seemed to have the meaningful use standard uppermost on their minds. Health systems far along in using health information technology noted that under the proposal they would not be equipped to be "meaningful users" until late 2011 at the earliest under the definition of the term in the proposed rule.

An official with Intermountain Health Care in Utah, a national pioneer in the adoption of health IT, said the proposal is "a bit concerning."

"I'd like to see more flexibility so we don't have to completely modify our strategy," the official said. In an earlier presentation to the AHA meeting Monday, House Democrat Chris Van Hollen, D-Md., said the Obama administration needs to modify the meaningful use proposal to avoid the adoption of systems that aren't as effective as they could be.

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