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Q&A with David Blumenthal, National Coordinator for Health Information Technology

David Blumenthal, M.D., M.P.P., is the national coordinator for health information technology at the U.S. Department of Health and Human Services Office of the National Coordinator (ONC). In the first installment of a new column called "Ask the Expert," States in Action asks Dr. Blumenthal to describe how ONC is working with states to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.

SIA: At the ONC, how are state-level HIT activities being coordinated?

Blumenthal: The ONC in collaboration with other federal agencies is addressing aspects of policy, technology design and adoption, privacy, cultural change, workforce, and sustainability as we implement the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA).

Two key points of coordination at the state level are through the funding of the HITECH Priority Grants Programs, which will support Medicare and Medicaid providers in their effort to qualify for payment incentives as "meaningful users" of electronic health records (EHRs). These programs include the:

  • State Health Information Exchange Cooperative Agreement Program
    This cooperative agreement program will support states and/or State Designated Entities (SDEs) in establishing health information exchange (HIE) capacity among health care providers and hospitals in their jurisdictions. Such efforts at the state level will establish and implement appropriate governance, policies, and network services within the broader national framework to rapidly build capacity for connectivity between and among health care providers. HIE is a statutory requirement to become a "meaningful user" of an EHR.
  • Health Information Technology Extension Program
    This program provides cooperative agreements for the establishment of Health Information Technology Regional Extension Centers that will offer technical assistance, guidance, and information on best practices to support and accelerate health care providers' efforts to become meaningful users of certified EHRs. This program will focus resources on primary care physicians to support their efforts to successfully implement and integrate EHRs in their practice.

ONC will be working collaboratively with State HIT Coordinators, SDEs, and Regional Centers within and across states in the implementation of these high-priority programs.

SIA: What are the key HIT activities states should be pursuing (electronic health records, health information exchanges, decision support tools, etc.)?

Blumenthal: State programs to promote HIE will help to realize the full potential of EHRs to improve coordination, efficiency, and quality of care. States will play an important role in collaboration with the federal government to establish the appropriate legal, financial, and technical support necessary to enable consistent, secure, statewide HIE across health care provider systems.

To enable an environment that supports sustainable HIE, states should be seeking multi-stakeholder consensus on activities across five critical domains: governance mechanisms, finance mechanisms, technical infrastructure, business and technical operations, and legal and policy issues.

SIA: Which states are ahead of the curve and why?

Blumenthal: States participating in the State HIE Program will begin at different stages of maturity working toward interoperable health information exchange. Some will be fully operational, while others will just be starting to build the necessary capacity.

The states that already have a significant amount of HIE across health care provider organizations have been planning and implementing governance, policy, technical, and financing mechanisms for HIE for several years. Strong leadership and consensus across public and private sectors on the statewide approach to HIE has been a contributing factor to their success.

The process of building HIE capacity begins with states assessing their current level of readiness. Once a state determines where it is starting, it can begin to map out a critical path to developing HIE for health care providers throughout the state. The programs are designed to support incremental change over a variety of health care settings, with the Regional Centers supporting providers with technical assistance to facilitate the adoption of certified EHRs.

SIA: What benefits can states expect from HIT?

Blumenthal: While we cannot answer on behalf of individual states, many health care stakeholders have noted the promise of HIT to improve the quality and efficiency of care. State public programs, such as public health and Medicaid programs, could significantly benefit from greater connectivity across health care providers and evidence-based delivery of health care enabled by HIT.

SIA: Do you think those expectations are realistic in the short term? What about over the long term?

Blumenthal: Yes. In the short term, we are providing important foundational funding and technical assistance to enable the adoption of health IT, building the means for greater connectivity across the health care system, and supporting providers' efforts to become meaningful users of EHRs.

Through the implementation of HITECH and successful collaboration with states and other key stakeholders, over time we can achieve the modernization of our health care system that is critical to improving our nation's health and reducing the cost of care.

SIA: What are the main challenges states are facing?

Blumenthal: Some of the challenges that states are facing include coordination across disparate pockets of information exchange in the health care system, implementation issues associated with budgetary constraints, the need for a trained workforce, and the establishment of a state-level legal and policy framework that must be in place to facilitate appropriate health information exchange.

SIA: How are the federal stimulus HIT grants affecting state activity?

Blumenthal: The HITECH priority programs are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, and ensure the workforce is properly trained and equipped to be meaningful users of EHRs. This support will augment the efforts of states that have already initiated programs, and jump-start those who have not yet advanced approaches to HIE across providers or have not been able to advance adoption of health IT throughout their regions.

SIA: Is the possibility of federal health reform affecting state HIT activity?

Blumenthal: We envision a health care system that delivers higher quality, safer, more efficient, accessible, equitable, and convenient care, enabled by health IT. This goal recognizes that the ability to capture, analyze, reference, and share clinical information relevant to each patient in a secure, digital format is fundamental to the level of quality and value health care all Americans should expect in the modern era.

Our current system is unsustainable. The adoption and meaningful use of information technology in health care represents a shift of historic proportion, and is central to the necessary reform and modernization of our health system.

SIA: How can states best learn from each other?

Blumenthal: There are multiple resources available to share best practices for health IT adoption through the State HIE Program, including ongoing forums where experts who have been involved in exchange in other states can share their expertise and best practices across the five domains of activity and in different health care settings. ONC supports the State HIE Forum, which is a learning community for all state HIT coordinators and SDEs. Through this forum, they'll problem solve together, share best practices, and receive the technical assistance needed to successfully achieve HIE across providers in their states.

The Extension Program will also establish a national Health Information Technology Research Center, which will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.

SIA: Any final advice to state policymakers and administrators?

Blumenthal: It is important to consider the power that states have through regulatory and policy levers to lay the foundation for and encourage health information exchange at the state level. Their support is critical to enabling the meaningful use of electronic health records—allowing for cost savings to individual state programs, improvements in quality of care, and system efficiencies to benefit the consumer.

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