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Shocker: Blumenthal Stepping Down as Federal Health IT Chieftain

By John Reichard, CQ HealthBeat Editor

February 3, 2011 -- A day after he was hailed by health information technology developers at a Health and Human Services press conference as a "rock star," National Coordinator for Health Information Technology David Blumenthal announced he is stepping down.

A professor at Harvard before taking the post in early 2009, Blumenthal said in a memo to staff that "I will be returning to my academic home this spring, as was planned when I accepted the position."

While that may have been known to insiders, it wasn't known widely. His departure will raise questions about whether the momentum toward IT adoption that picked up with passage of health IT provisions in the economic stimulus law and their implementation under Blumenthal's leadership will be lost when he heads back north.

Blumenthal has been skilled at communicating the importance of the technology to lawmakers and the media, an attribute perhaps perfected because of his own lack of a technical background. Blumenthal quips that his wife is the one in his household that takes charge when the computer is on the fritz.

But he also has won praise from technical experts on the private sector side of IT, who joined in announcing recent strides in developing a national system of health information technology exchanges.

David Brailer, who preceded Blumenthal as head of the Office of the National Coordinator (ONC) for Health Information Technology, at once praises Blumenthal's contributions and says Blumenthal is not essential to continuing the momentum developed in IT adoption.

"What David did is turn the health IT movement and ONC from kind of an insurgency into an agency. David's turned it into a real agency that has real clout with real depth of working relationships with FDA and Medicare and Congress," Brailer said. "There are people like me who start new ideas and businesses, and people like David who turn it into a big successful thing." The depth of the agency will help carry IT programs forward, he added.

But Brailer said it's still an open question how widely doctors will take up health IT, despite strides made in areas such as funding, the creation of regional technical assistance centers, training of health IT technicians, and Medicare rulemaking to pay more to providers who make "meaningful use" of the technology.

With doctors continually facing Medicare payment cuts, it's not clear that incentive payments are going to be enough to spur their adoption of the technology, he said.

Brailer said he saw the departure coming because the tenure clock was ticking. "Harvard's one of the sticklers for 'you use it or lose it,' and if you don't go back on their clock, they have very little tolerance for people who do that."

Blumenthal's announcement to staff about his departure said "we still have important work to do together, including the assurance of a productive transition for ONC." But he pointed to hopeful signs concerning health IT adoption, while also noting various programs created under stimulus law provisions known as the Health Information Technology Economic and Clinical Health (HITECH) Act.

From 2008 to 2010 the percentage of primary care physicians who have adopted an electronic health record system climbed from 19.6 percent to 29.6 percent, he said. In addition, 41 percent of office-based doctors and 81 percent of hospitals said at the end of 2010 that they intended to take steps to qualify for higher Medicare payments made to those who meet the regulatory criteria for meaningful use.

HITECH allocated as much as $27 billion for incentives to adopt IT including the meaningful use standard. Blumenthal said the money is crucial but the key factor is the meaningful use concept developed in rulemaking. "Meaningful use provides, for the first time ever, a consensus goal on how information should be used to enhance care," Blumenthal told staff.

He also pointed to initiatives put in place with an additional $2 billion provided under HITECH. They include 62 "Regional Extension Centers" to answer questions from providers nationwide about adopting and running health IT systems, "with special attention to smaller primary care practices and rural hospitals."

An estimated 38,000 providers have registered for assistance from the centers.

Also, 84 community college programs have been established to help build a health IT workforce that includes training for nurses, physician assistants and other health care workers. Seventeen "Beacon" communities have been named to demonstrate how health IT resources have been pulled together to meet local health care needs.

The health industry has expressed during Blumenthal's tenure that government was pushing hard for IT adoption with no guarantees in place that the technology involved would be "interoperable" – that computer systems would work together. The meaningful use payments will hinge on whether the government has certified the technology used as interoperable, yet that program hadn't really gotten off the ground. But now a total of 291 electronic health record products have been certified as interoperable and therefore as qualifying for higher Medicare payments under the meaningful use standard.

HHS officials didn't immediately respond to queries on who might succeed Blumenthal or fill his spot on an acting basis. Farzad Mostashari, who oversaw health IT adoption by 1,500 providers as an official with the New York City Department of Health, serves as deputy national coordinator for programs and policy with the HHS Office of the National Coordinator for Health Information Technology.

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