At Medgadget we have covered a variety of advances in health information technology (HIT) and electronic health records (EHR). The Centers for Disease Control estimated that the adoption rate of electronic health records among physicians was nearly 50% in 2009 – a sign of increasing use among healthcare providers. We had a chance to speak with Dr. David Blumenthal, former National Coordinator for Health Information Technology and current Chief Health Information and Innovation Officer at Partners Healthcare System in Boston, MA, about his role in encouraging the spread of HIT and his opinions about its future.
Ravi Parikh, Medgadget: Can you give us a brief overview of your recent role as National Coordinator for Health Information Technology and what you were able to accomplish in your two years in Washington?
Dr. David Blumenthal: We established the strategy for a nation-wide health information network, several technical assistance programs, and a certification program for electronic health records. We also began a process of mobilizing state involvement in a health information exchange. We also created an Office for National Coordinator for Health Information Technology that established the credibility of that office to take on future leadership roles in this arena. The adoption of EHR is proceeding today at a fairly rapid clip. That’s a consequence of the Affordable Care Act and the Centers for Medicare and Medicaid Services plays a big role in that, so success is not just the work of the Office of the National Coordinator.
Medgadget: We have read about your work in building a secure, interoperable nationwide health information system as NCHIT. What do you think is the status of such an effort, and do you think we will see such a system in the near future?
Dr. Blumenthal: You can’t have a network until you have electronic information. We need wider adoption and meaningful use of EHRs. There are many local efforts to create information exchange. In areas of high uptake, there are examples of success from a technical standpoint. However, there are fewer examples of success from an economic and social standpoint. So the big obstacles to exchange are social, political, economic, and cultural. We need a really compelling case for organizations that have successful systems to share with others and deal with the logistical annoyances of making that possible. Right now I don’t think that situation exists. Until it does, we can throw at this all the technical solutions we want and it will not have much effect.
I think one of the positive developments recently is the availability of a simple email solution for exchanging health information securely – the so-called “direct project”. There is now open-source, standard-based software for exchanging health information record-to-record using email. That is not the end solution, but it’s a step on the way. I hope that changing pressures on the health system will encourage people to adopt and use such technologies and that they will get attached to exchange and thus want it to succeed. But there needs to be sufficient demand for exchange of health information for that to happen.
Medgadget: And what do you think those pressures will be? What incentives can we design to promote assimilation of HIT?
Dr. Blumenthal: The question is who “we” is. In the state of Massachusetts, the government and private sector have created a compelling case through global budgeting and state regulation requiring information sharing through health information technology. There are other states enabling it through a tax/levy on insurers. In states like Delaware and Minnesota local health insurance exchanges are working well. Ultimately what is needed is for providers to believe that health information technology is essential to their work. Until we get there, widespread adoption won’t be possible. I think right now, health information exchange is dependent on government to change the way care is paid for and create regulatory requirements. Meaningful use can up the level of requirement-related exchange. But, on the whole, it will be things not related to technology that need to happen.
Medgadget: I imagine a significant part of your former and current positions involve evaluating existing technology. What advice do you have for private developers of electronic medical information systems in terms of means to improve upon current systems?
Dr. Blumenthal: Well, for example, they need to be looking to cloud-based systems; they need to be developing strategies to guarantee increased security and privacy. They need to build in exchange and use standards that are being developed by the Office of the National Coordinator. Ultimately they need to anticipate the requirements for accountability as our health system becomes more expensive and therefore difficult to maintain.
Medgadget: On our pages we have recently covered technologies that put medical information in the hands of patients (example). What is your opinion of such a trend, and what issues do you see in terms of patient safety and confidentiality with increasing access to medical information?
Dr. Blumenthal: If you ask me in 50 years, I have no doubt that mobile medicine will be an important movement. However, if you ask me where we will be in 5 years, I am skeptical that large numbers of consumers will be using mobile health devices or information to manage their own health. Surveys show that the overwhelming majority of Americans believe the best source of information about healthcare is still people’s physicians, and that is where people tend to look for direction. I have seen no evidence other than a tiny fraction of an elite part of our population that there is any great appetite of people to collect, steward, and maintain their own information through mobile technology right now; however, that may certainly change.
Medgadget: Just as an aside, we have also covered mobile-based/web-based apps that generate differential diagnoses. In your role as a practicing physician, what do you see as the role of primary care physicians in dealing with information patients face and bring to their doctor?
Dr. Blumenthal: That question reminds me of a patient I saw 3-4 years ago who emailed me – a very intelligent man. He had decided based on his symptoms that he had a gallbladder-related disease. He had several reasons to conclude this based on what he learned from websites. When I actually saw him, however, I was convinced based on a thorough history and physical exam that he had pleuritic chest pain (based in the lungs) and not abdominal disease. He actually ended up having viral pneumonitis confirmed by chest x-ray. What stories like this show is that self-administered diagnostic algorithms are not going to be sufficient to substitute for a thorough history and physical combined with laboratory tests. People will put their symptoms into these algorithms and say “Doctor I think I have this.” And maybe 40-50% of the time, they will be right. However, we still need the appropriate diagnostic tests to confirm this. Most people will not be content with a 50 percent likelihood of a correct diagnosis based on the incomplete information available to them.
Medgadget: Could you tell us a bit about how your priorities serving as a federal regulator of HIT differ from your current role as Chief Health Information and Innovation Officer at Partners Healthcare System?
Dr. Blumenthal: My current role is rather specialized, and that is to run the remaking of our electronic health information system. So I am not maintaining our current system, but rather planning and implementing our acquisition of a new health information system. Even in that, Partners is not unique: we are acquiring the EPIC platform in which several hundred other health systems are involved. What is unique here is the size of Partners – our clinical, educational, and research systems – and the fact that we are located in a market with universal coverage and much more emphasis on cost constraints than in other markets. So I think that we have an opportunity to use the technology better and on a larger scale than other systems do.
Medgadget: Health information technology obviously represents a tremendous opportunity for improvement in healthcare quality. How did you become involved in the effort years ago, and did it take a significant amount of foresight on your part?
Dr. Blumenthal: It wasn’t because of foresight – I was never interested in the technological aspects earlier in my career. I was actually forced to use an electronic medical record as part of my practice, and I came to the conclusion that this was a very important change in healthcare. Then I began studying it as a policy issue. It was because of that policy interest that I became a figure on the national scene. I came to appreciate the importance of it not because of my fascination with the technology, but because of my understanding of the power of information in all areas of human endeavor – particularly in the medical arena where information is the core resource.
Dr. Blumenthal is a pioneer in the HIT movement, and it was a privilege to get his perspective on the future of electronic medical records in our everyday practice. We at Medgadget look forward to the greater role of electronic health records and technology in our future medical environment.
Here’s a video of Dr. Blumenthal speaking about HIT: