HIMSS14: National coordinator panel covers challenges, goals

ORLANDO—“Better care, better health, lower cost.” Those are the priorities that should drive health IT in the next decade, according to former national coordinator for health IT, Farzad Mostashari, MD, MSc. He was part of a panel that included two other former coordinators and current coordinator, Karen DeSalvo, MD, MPH, MSc.

“The cost piece around waste reduction as a first step is so important because that allows us to reinvest those funds,” she said.

When asked what providers will respond to in the next stages of health IT adoption, David Brailer, MD, PhD, said, “Adoption of what? That gets to the question of what is the mountain that needs to be climbed?” The current effort to drive HER adoption isn’t one and done, he added.

“The technology itself sometimes gets in the way of some of the desire to achieve these no-IT solutions,” said Robert Kolodner, MD, referring to improved interoperability and patient outcomes. “When you buy a product, you buy a workflow.”

“Success is not measured by how many billions are spent on health IT,” said Mostashari. The app world has spent a total of $8 billion, he said, which is one-fifth of what we spend on health IT in one year and apps have arguably had a much bigger impact on everyday life and experience.”

DeSalvo said she is interested in seeing how consumer drivers will force providers to adopt health IT in ways that are more accessible. “Patients are going to start to demand this in a way we haven’t experienced before.”

When asked what role government should play in overseeing health IT, DeSalvo said the government has a role, responsibility and opportunity. “We’re accountable to every American in a way no hospital, provider or vendor is.” She noted the need to “correctly set the dial so we’re regulating just enough. We need to protect issues around privacy and security but not have so much regulation that we squash innovation.”

Too much regulation has “an oppressive effect on industry,” said Brailer. And while regulation is necessary, it’s not enough, he said. With so many government agencies involved in Meaningful Use and healthcare reform, he worries that after the incentive program concludes, we could go right back to confusing, conflicting messages which are self-defeating. He said the coordinator role is “absolutely essential.”

“A defining trend over the next decade is going to be consumer unrest over healthcare,” he added.

An audience polling question revealed the majority think the most desirable role for the government to play is mandating the use of interoperability standards. While DeSalvo said that probably reflects the need for clarity and guidance, Brailer said it’s a “worrisome trend.” Once people are paid to do something, when the money stops, they often revert to previous behavior. “Market forces will have to come back but there’s not going to be an appetite to spend another $20 to $30 billion” on driving further health IT efforts.

The market also demands mandates, he said. “Incumbents love regulation because it protects them from innovation. If I was a vendor I would beg for mandates because it would lock in my market share.” That makes it more difficult for newer, smaller companies to enter the market.

The effort to improve interoperability is best focused on the ambulatory market, said Kolodner. “When you make a massive effort, you’re set up for failure. If you concentrate on interoperability in the ambulatory setting, you’re going to be able to get moving much faster. The systems are smaller and the amount of data is much smaller and more defined.”

An audience member asked the panel how to ensure data exchange is accurate and complete. “In a perfect world, we will know all that is known about someone’s medical status.” However, people are responsible for making sure their own credit card and bank account information is complete and accurate. He called for medical schools to do more to train physicians to live in the digital world because doctors need to serve as advocates for their patients. “Until the system can do all this, it’s the doctor’s job.”  

Waiting until information is complete and accurate before it’s shared is “absolutely the wrong answer,” said Mostashari. “We get data accurate by sharing. Once you start exposing your data to other people, the quality is exposed. How do you get accuracy? Share it. Some information is better than no information. Just start sharing.”

Kolodner agreed. “We do assume [data are] incomplete. Sharing with the patient is the most important thing. It’s something to aspire to, not something to wait for.”