A tough act to follow

Mary Stevens, editor, CMIO

At the Direct press conference earlier this week, many of the speakers began their presentations by lauding David Blumenthal, MD, ONC chair. Here was “the man who set in motion so much of what has happened, incredibly, in the past 18 months,” said Farzad Mostashari, senior advisor for policy and programming at ONC, in introducing him during that event. Others just called him a rock star.

Later, during a question-and-answer session at the same event, the disconnect between what the ONC is trying to communicate and what the public hears cut through some of that admiration. The press conference was about the launch of Direct Connect projects in Minnesota and Rhode Island, but a listener cited the recent Archives of Internal Medicine study that found almost no clinical benefit to EHRs with clinical decision support. “I’m hearing a lot of religion and I want to hear some science,” the caller said to Blumenthal. “Do you have any data that show all this work that everyone is so enthusiastic about is actually going to benefit, improve the care the patient receives?”

Blumenthal replied that he doesn’t consider that database a very sensitive one, and pointed out that the study used data from 2005 to 2007, and “not with EHRs in their modern form and not under the influence of meaningful use requirements, which require higher levels of performance. Peer review studies show benefits of cost reduction and quality improvement. And there are much more methodologically sound ways of trying to assess that, he said.

“There are plenty of strong studies that justify what we’re doing,” he said. “There are plenty of physicians who are using EHRs who will never go back to paper. I saw the value in my own practice.

“Beyond that, the idea that in 21st century America we will withhold from patients the benefit of electronic systems when the rest of the world is zooming ahead with ever more powerful uses of information for the rest of their lives, strikes me as inconceivable as well as irresponsible." With that, the questions returned to Direct Connect and HIE.

Blumenthal’s announced intent to resign and return to Harvard in the spring will be a loss for the notion of national health IT.

A less-contentious Congress passed the legislation that authorized the ONC to create “a nationwide, interoperable, private and secure electronic health information system.” The Direct Connect projects shows that technical obstacles to HIE can be overcome; not so much the political forces. Blumenthal’s replacement will have a tough act to follow, not to mention facing a tougher audience.

Mary Stevens
Editor of CMIO
mstevens@trimedmedia.com