Dr. David Blumenthal and his staff at the Health and Human Services Department are charged with building a nationwide health information technology infrastructure. (Jonathan Kannair)
Dr. David Blumenthal leads the Office of the National Coordinator for Health Information Technology (ONC) at the Health and Human Services Department, where his staff is charged with building a nationwide health information technology infrastructure. Appointed in April 2009, Blumenthal is tasked with ensuring that every physician's office and hospital by 2014 is using electronic health records and bringing down the cost of health care.
He previously served as a physician and director of the Institute for Health Policy at the Massachusetts General Hospital/Partners HealthCare System in Boston and has used electronic records to care for patients for 10 years, according to an HHS news release. He also served as a professor of medicine and health care policy at Harvard University Medical School and as director of the interfaculty program for health systems improvement.
Following are excerpts of an interview in which he describes progress in the program that will pay incentives to health care providers who make "meaningful use" of electronic records and take steps toward staffing regional extension centers to train providers as they set up electronic systems:
Q: Earlier this year, you mentioned that the ONC's focus will shift from policy to implementation. When will that shift occur, if it hasn't already?
We've now got in place all the regulatory apparatus that is needed to support the incentive program. That all had to be created from scratch. All of it's rather, I think, historic for this country and even internationally. And I think we are pleased that we've gotten all that behind us and can now focus on the next task, which is to support providers in taking advantage of the meaningful-use incentive payments.
Q: How has your office grown to accommodate the ONC's responsibilities?
As I look back on what we've done since I got here in April 2009, it is an awful lot. And for that I am greatly indebted to a terrific staff, which has grown but is still very small. We have probably only about 110 people working in this office. We have some very technical people who are experts on the standards and certification processes for electronic health records and know how to develop standards from scratch, and folks who are experts at developing new software solutions. We also have communications people. We have folks who have run on-the-ground provider-support programs. We have folks who have run community-wide health care collaborations. We have budget people.
Q; Ideally, how many people will be needed to continue this work as the needs grow?
I'm not sure I feel comfortable giving you a specific number. We're growing to fill our needs as we understand them, but I do expect we'll continue to grow over the next year.
Q: Describe the work ahead for the ONC.
We need to fill out our program staff. We have 60 regional extension centers, [but] we still don't have enough people to really monitor and support their performance. We have given every state and territory a cooperative agreement to promote health information exchange. We still don't have enough program staff to relate closely to every one of those states at the level of service that we think is going to be necessary to get the results we want.
We still are developing our basic services, like our oversight capability, so that we are keeping track of our grantees and their reporting on budget [and] use of budgetary money, and we are getting good, accurate reporting on their accomplishments. We didn't have a grants office here when I started. We now have a grants management office, [but] we haven't fully staffed [it].
All the things that ongoing federal agencies take for granted once they've been in business for a decade or so, we've been having to create.
Q: What challenges has your office faced or expects to face?
Our overwhelming challenge is that we have to convince skeptical, busy hospitals and doctors that they should adopt electronic health records and use them in a way that will qualify them for the incentive payments that we are offering. They'll do that now with meaningful use as we've defined it, and [the hope is] they will continue to do it as we change and increase the rigor of the meaningful-use definition. And all that is still to come. We really are in the business of winning the hearts and minds of the nation's doctors and hospitals.
Q: Is there a timeline or schedule outlining the ONC's work?
We are working on a strategic plan that's required by the law. ... I hope that it will be out in the spring. It will give our long-term and short-term goals and objectives.
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