The Best Laid Plans…Laid Waste? ONC and CCHIT and the future of health IT

With some fanfare, in 2004, President George W. Bush (Bush, the younger) made the national rollout of health information technology a federal government priority when he established the Office of the National Coordinator of Health IT. Dr. David Brailer was tapped to be our first “health IT czar” at ONC. He had a stellar resume and did a commensurate job. He went on to lead a private equity fund that invests in health technology.

When Dr. David Blumenthal, a Harvard Med School prof, took over the post of Coordinator in 2011, he implemented the Meaningful Use plan. It was well-thought-out, stepwise. It had carrots and sticks, and a timeline for implementation. Given the state of electronic patient records in all 50 states, more than 5,500 hospitals and hundreds of thousands of individual practices at mostly the paper-and-file-folder stage of recordkeeping in 2004, it was a gargantuan undertaking. Dr. Blumenthal also was a serious intellectual powerhouse, which is redundant with Harvard Med School prof.

Dr. Blumenthal’s successor, the bow-tied Dr. Farzad Mostashari who stepped down last fall to lead his own company focused on the future of healthcare, was instrumental in the creation of the Certification Commission for Healthcare Information Technology (CCHIT), a certification and accreditation body. That was a huge step forward, as it required anybody building patient record software in their mom’s basement to make sure it could play nicely with all the other software and perform as advertised.

On some level, Meaningful Use has achieved some meaningful change. First, the carrots and sticks worked and people sat up and paid attention. Providers bought electronic patient record systems, some out of fear or greed, but they bought them. (Hey, fear and greed are powerful motivators!) They tried to use them, some successfully, some very successfully, and some not so much. But certainly, the Meaningful Use initiative moved the needle. Where we had about 9% of doctors using electronic prescribing at the start of this effort, I saw a statistic last week that puts it over 50%.

Dr. Karen DeSalvo was called into service as our latest “health IT czar” in January 2014. Dr. DeSalvo is yet another powerhouse in her own right, who was down in the streets putting New Orleans’ healthcare system back together after Hurricane Katrina. That will get you known around town as somebody who gets things done. So Obama tapped her to take over ONC when Dr. Mostashari resigned to lead his own company focused on the future of healthcare.

Which leads us to Dr. DeSalvo’s current task. ONC is a big job; the czar appellation makes it clear that it is important. When the Ebola panic struck, the Secretary of HHS Sylvia Burwell “snagged Karen DeSalvo to help in the Ebola fight,” according to an article titled DeSalvo to Juggle ONC, Ebola Work by Tom Sullivan in Healthcare IT news on October 28. The article went on to say:

Dr. DeSalvo will serve as Acting Assistant Secretary of health ‘while maintaining her leadership of ONC. Importantly, she will continue to work on high-level policy issues at ONC, and ONC will follow the policy direction that she has set.‘ (Sullivan quotes HealthITBuzz here)

Moving such a git ‘er done woman to this other post might lead some people to conclude either:

A. The country’s health system emphasis has shifted from electronic patient records to fighting Ebola
B. The Dallas hospital where Patient Zero Duncan died originally blamed the electronic patient record system for the failure to treat Duncan promptly so someone decided we need a “health IT czar” to lead the Ebola fight
OR
C. It is clear the future of health IT is headed in a different direction than ONC, so it’s time to quietly dismantle an outdated idea.

My tea leaves are soaked in sweat as I carefully cast my vote with Option C. Another little news item last week tipped the scales for me.

In the wake of moving Dr. DeSalvo directly under Burwell as Acting Assistant Secretary of Health, that accrediting body CCHIT that Dr. Mostashari initiated during tenure as “health IT czar” was dismantled the next day. They were told to go home, we don’t need you anymore.

An article in HealthData Management on October 28 titled CCHIT Announces It Will End Operations by November 14 by Greg Slabodkin contained this statement from CCHIT’s executive director:

[The] slowing of the pace of the ONC 2014 Edition certification and the unreliable timing of future federal health IT program requirements made program and business planning for new services uncertain.

Maybe those former czars who’ve gone on to fund the future of healthcare sent back a memo saying the techies in the trenches got this covered. They are way ahead of you out here in the field.

Now I’ll dry out my tea leaves to be reconstituted another day.

Peggy Salvatore writes on healthcare and business issues as Health Business Communications. She has recently published an Amazon ebook Working with SMEs: An Instructional Designers Guide to Gathering and Organizing Content from Subject Matter Experts.