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Health IT--and Blumenthal--Step into the Spotlight

By John Reichard, CQ HealthBeat Editor

May 20, 2009 -- The Obama administration's top health information appointee noted Wednesday that there's considerable skepticism since lawmakers put almost $20 billion or so into the stimulus law to further adoption of the technology that it can deliver on promises to improve quality and lower costs. But he said it can play a "critical" role in a revamped health system because of the importance of information in health care decision making.

David Blumenthal, appointed by President Obama to head the HHS Office of the National Coordinator on Health Information Technology, told a Brookings Institution seminar that the intellectual challenge of designing an improved health care system is solvable but the problem the nation faces is mostly about getting to some type of consensus on system changes among the various groups involved in the health care system. "Remarkable progress" is being made toward that end this year, he said.

Blumenthal says that in the "enormous agenda" of streamlining the health care economy to produce lower rates of spending growth, health information technology has a critical role "because it is a manager of information—and we are above all in the health care industry about using information to make decisions. Anything we can do to make the management of information more effective to get better information to the point of key decisions at the right time is going to ultimately improve the quality of those decisions and the products that our health care system produces."

Blumenthal noted that his own office has moved into the spotlight since the stimulus legislation passed because its budget has grown from some $60 million to $2 billion, reflecting the grant programs it will handle for programs such as building up a health IT workforce, establishing resources to help providers adopt the technology and aiding the creation of broad health care information networks.

As it takes on less of a role as a bystander advising the HHS secretary to a more central position responsible for fostering the adoption of the technology, the office will seek much public input in developing a regulation governing increased Medicare and Medicaid payments to doctors who make "meaningful use" of the technology, Blumenthal said. The definition won't pop out "fully formed" from the federal government without "enormous" public input, he said. "Meaningful use" is focusing policy makers on payment for the outcomes of the use of the technology rather than on the processes involved in the technology, he said.

"We're going to have to talk about what we will measure to decide whether meaningful use is occurring—an enormous challenge in itself," he noted.

Stimulus money coming to providers to help with adoption costs may be the key factor for some providers, but overall, Blumenthal said "this is not about the technology, and ultimately I hope it's not about the money. If we can show physicians and hospitals that they can be better at their basic work with this technology than they could ever be without it, if we can show the value that it provides day in and day out in the provision of patient care, if we can show that same thing to the American public, then I think the money will be a sweetener but not a determinant of adoption."

It is fast becoming clear that to become a competent health professional requires a facility with health information technology, Blumenthal said. He predicted that it ultimately will be so much a part of the culture of the practice of medicine that just as the federal government doesn't provide stethoscopes and examination tables, so too will health IT be adopted without full government reimbursement, he said.

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