Wednesday, November 5, 2008

Healthcare IT in the Early Obama Administration

When Obama takes office in January, the economy will be his first priority, followed by the war in Iraq. Healthcare will follow as his next major issue to address.

What will he do?

I imagine he'll take a phased approach to ensuring all Americans have access to healthcare. Given the change management needed to accomplish this, it will take a while.

However, Healthcare Information Technology has broad bipartisan support and is his best strategy to reduce healthcare costs, reimburse providers for quality instead of quantity, and to ensure coordination of care. Here are my predictions for healthcare IT in the first year of the Obama administration:

The AHIC Successor, with its board of 15 savvy operational people and 3 incorporators (John Tooker, John Glaser and Jonathan Perlin) will serve as the public/private collaboration for prioritization of healthcare IT initiatives during the first year of the Obama administration and likely beyond.

The Office of the National Coordinator (Rob Kolodner) will continue to coordinate Federal input into the public-private effort.

The Health Information Technology Standards Panel (HITSP) will continue to harmonize standards. Its work in 2009 will include

One new use case to harmonize the electronic standards needed to exchange data about newborn screening for treatable genetic, endocrinologic, metabolic and hematologic diseases.

Closing gaps in standards for
General Laboratory Orders
Medication Management
Advanced Device Interfacing
Clinical Notes
Order sets
Secure Data Transport for all clinical data
Consumer Preferences for care
Clinical Registries
Maternal/Child Health
Long Term Care Assessments
Prior Authorization for testing
Consumer Adverse Event Reporting

Additionally, HITSP has the AHIC Successor's endorsement to work on standards for Clinical Trials and Research in collaboration with CDISC and other stakeholders.

The Health Information Security and Privacy Collaboration (HISPC) working groups will continue to inventory and harmonize privacy standards for states and territories

Hopefully the Obama team will offer incentives to implement EHRs early in the administration, but in the meantime hospitals will subsidize 85% of EHR implementation costs via Stark safe harbors and private payers will offer pay for performance incentives for the outcomes resulting from the use of EHRs and e-Prescribing.

States such as New York, Massachusetts, Tennessee, Indiana and Utah will continue to implement regional data exchanges that meet the needs of their local stakeholders.

The Certification Commission for Healthcare Information Technology will continue to develop functional criteria for EHRs, PHRs and Health Information Exchanges. HITSP harmonized standards will be included in CCHIT criteria and incorporated into EHRs in an incremental way over the next few years.

Thus ONC, the AHIC Successor, CCHIT, HITSP and HISPC will continue their work for the next year. My personal leadership role of HITSP continues until October 2009, crossing between administrations.

After the year it takes to stand up a new administration, we may see additional resources for healthcare IT, a new federally regulated exchange where Americans not covered at work would be able to choose among a variety of private group policies and a new public program to compete with the private insurers. New public and private IT initiatives will be needed to support the workflow of these new programs.

Next week, I'll be in Washington for AMIA, the last meeting of the AHIC, and an FDA meeting. I'll report on how the transition teams are beginning their work and the implication for healthcare IT.
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