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ARRA: A New Era for Health IT, and for CCHIT – Part 1

Mark LeavittWhen President Obama signed the American Recovery and Reinvestment Act (ARRA) into law, health IT
was catapulted into a new era.  I believe this is — and forever will be — the biggest milestone in the history of health IT.  I’d like to share my perspectives on it, but it will take several blog posts to cover such a big topic.  Today, I’ll start with a high level view of the significance of this event, and talk about some of the confusion that has resulted from the injection of so much new money – and with it, some new politics – into the world of health IT.  Then I’ll follow up with posts that delve into the details of how I believe CCHIT will need to evolve in this new environment. 

I’m personally struck by the parallels to a historical event still vivid in my memory: Project Apollo, President Kennedy’s incredible national goal of achieving manned spaceflight to the moon.

Apollo cost $22B (in 1969 dollars, now worth five times that) and took 8 years to achieve the first moonwalk.  NASA, a new government agency, spearheaded the effort, but the technology was developed by private sector contractors.

The health IT provisions of ARRA invest at least $35B to incentivize full EHR deployment, allowing 5-7 years to reach that goal – remarkably similar to Project Apollo.  The Office of the National Coordinator (ONC) has been codified and funded to lead the effort, and just as in the case of Apollo, I expect much of the work will need to be accomplished by contractors in the private sector — CCHIT included, of course, provided we quickly “grow up” to meet the enlarged responsibilities. 

But here’s the key difference: for Apollo, the critical challenge was in the development of new technologies.  The only people who had to “adopt” the new technologies were the astronauts.  In contrast, although ARRA requires some degree of advancement in technologies, its real challenge lies in changing the behaviors of hundreds of thousands of individuals, and thousands of organizations, across the health care industry.  Audible “gulp” here.

This takes something money can’t buy:  inspiring, consistent, trustworthy leadership.  We need that leadership right now, but we are in the midst of a major political transition.  We have a bold new President and landmark legislation, but very limited information on how it will be implemented.  Whenever there is incomplete information, rumors and speculation circulate to fill the void.  But I’m confident the noise will dissipate as fresh, accurate information begins to flow.  And my goal in the blog entries that follow will be to provide what factual information is available, and to offer my own opinions that are clearly identified as such. 

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mary sarchetDon Nease, MDAaronContrarianHealthcare Guru Recent comment authors
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mary sarchet
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mary sarchet

hello. i am a 50 year old single woman with one child. living in a small town with not much work so i live on a tight budget and what are we auppose to do for health care. i can,t afford any coverage and the coverages that are out there for 250 bucks a month do not even cover all that is needed for a 50 year old person. also many will not even take you with pre existing conditions and i have asthma so i just get lost in the shuffle i guess. and its awful scarey at this… Read more »

Don Nease, MD
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Don Nease, MD

First, a disclaimer. I consult with and serve as CMO for Cielo MedSolutions, LLC, who has commercialized software we developed inside the University of Michigan. As an academic family physician researcher I’ve worked with and studied HIT since residency 20 years back. My comments speak mainly to the challenges of HIT implementation in primary care. I think some caution should be advised when considering behavior change in order to deploy HIT. To an extent I agree, some aspects of primary care workflow are long overdue for examination and redesign. If the Patient Centered Medical Home movement lives up to it’s… Read more »

Aaron
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Aaron

Yes, Apollo was a joint effort between government and private industry, with private-sector contractors developing the technology. But in the end, the government owned, operated and maintained the hardware/technology that was produced by private industry, all in pursuit of a public mission that was government directed. And that’s what’s missing here. The government is “incentivizing” ehr with public monies, but the product will be owned by private entities all acting independently, without an overarching goal directed by the public. The money is from the public till, but it is hard to see what health technology infrastructure the public will inherit… Read more »

Teresa Sharkey
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Teresa Sharkey

I agree with healthcare GURU, I was at Duke University when CPOE (computer physician order entry) “rolled out”. It was a mess. We all were excited about the technology, but were disappointed with the results to say the least. In theory it was a novel concept, but again theory and practicum don’t always mesh (espescially in healthcare). As with other healthcare programs it fell short time and again. I think some programs like EMAR, Meditech, HSM, CMS and adhoc definitely have positively impacted us in some ways but have hindered us in just as many. The main problem is that… Read more »

Contrarian
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Contrarian

To bring the analogy back down to earth, I fly a 737 EMR in my office, a 747 in hospital A, a 767 in hospital B and a 717 in the surgery center. Eventually I’ll have to fly a 777 when I can no longer practice solo and join a group. Since no two systems are remotely alike, how can I offer better care?

Healthcare Guru
Guest

I have experience with some of the existing products. When I heard first time complain about doctors intransience to CPOE, i started asking question. You would realize is that in the form, it is waste of time. It takes a phsician less than 30 second in most cased to write presecription…and I can tell you that it will take alot more with current for of CPOE in addition to it being cumbersome. That is not to say it can not be made to compete with the current paper-pen system. While CPOE may be good concept, but its adoptation is mostly… Read more »

Peter
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Peter

“This as a goal is akin (using your NASA analogy) to having a goal of deploying a bunch of rockets for astronauts to fly.”
My take on this as well. I’ve always said NASA budgets exist to provide interesting jobs for smart people. I’ve yet to see tangible benefits for the taxpayers funding it. I can see some benefit for health IT (imaging) but don’t see it as our savior for cost control or better outcomes. Healthcare is a people business, IT makes it a machine business.

J. F. Sucher, MD FACS
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J. F. Sucher, MD FACS

Mark, First, I am a huge proponent of improving patient safety and quality of care through the implementation of computerized clinical decision support and other HealthCare IT tools. But I think that people have valid concerns about a couple issues as it relates to the spending on HealthIT throug this ARRA. First, there is a concern about the goal. That is, “to incentivize full EHR deployment”. This as a goal is akin (using your NASA analogy) to having a goal of deploying a bunch of rockets for astronauts to fly. This should not be the goal. The goal should be… Read more »

Dr. Rick Lippin
Guest

Thanks-Excellent.
I believe the key to much of this is bringing in sociologists who study health organizational(user)cultures BEFORE any HIT is implemented.
But techies and greedy vendors are eager to dismiss such “soft science”
Prof.Ross Koppel from University of Pennsylvania is such a sociologist who publishes on HIT.
Read his publications (JAMA etc) before you leap to fast and to far.
Dr. Rick Lippin
Southampton,Pa

Teresa Sharkey
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Teresa Sharkey

I must admit I am certainly not an IT professional, but I have used many of the healthcare computer charting programs like CPOE, Meditech, EMAR, HSM, just to name a few. I would say that I do agree with Mark that the real concern/problem will be educating healthcare workers. As with any new “revelations” in improving healthcare and its delivery, there is always going to be the “human” element as well as legal ramifications for such. Sure the “astronauts” of the program will be on the top of their game but at the end of the day it will always… Read more »