Physician informaticist Robert Kolodner took time out Thursday for a telephone interview to talk about his appointment by HHS Secretary Mike Leavitt as the permanent head of the Office of the National Coordinator for Health Information Technology at HHS and his bidding adieu to a career serving the nation's veterans.
Kolodner has been interim national coordinator since Sept. 20, 2006, following the resignation last spring of David Brailer, the first to hold the top job at ONCHIT.
It will mean saying goodbye "with fond memories," he said, to a distinguished career at the Veterans Affairs Department, which was called the Veterans Administration when Kolodner started working there more than 28 years ago. Kolodner was chief health informatics officer for the Veterans Health Administration, the healthcare arm of the VA that operates nearly 1,300 care sites.
"I'm in this as a career appointment," he said. "This is a total transfer, moving from one department to another. Before I was on detail (from the VA). Now I will be a full HHS employee."
Kolodner, 58, a psychiatrist, took to computers early when he came to the VA in 1977 and was in on the ground floor of the development of what would become a nationally interoperable clinical computer system, now called the Veterans Health Information Systems and Technology Architecture, or VistA.
Kolodner said he leaves the VA, "feeling very gratified that it has demonstrated as well as any other system out there that the use of health IT becomes a fundamental, necessary component of transforming healthcare to be able to provide the highest-quality, safest care in a very efficient, cost-effective manner."
At HHS, his duties and powers will not change with the permanent appointment, Kolodner said. "In terms of what I'm doing here, it's going to be the same. From the time I came in the door the secretary has empowered me. That said, I think there is a perception issue from the outside, (that) now, OK, they're serious about this."
When discussing the future healthcare environment and the impact healthcare information technology will have on it, Kolodner still refers to recipients of healthcare as "patients," even though the phrase "healthcare consumers" is the current vogue.
"That environment is going to have several components," Kolodner said. "It's going to be centered around the patient. When it's healthcare, it's more or less the patient. When you're into wellness care, you're still a patient, but you're not sick.
"We're here to serve the individual and we're here to maintain their health. It's this whole thing of helping individuals manage their health by having the necessary resources and information and tools to do that management. All of this has to occur in a private, secure and confidential environment ... so their information is not used against them."
Regarding Brailer, Kolodner said he has "the utmost respect" for putting all of the activities in motion to expand the nation's healthcare IT system inside the government and outside it, adding that a big part of his job will be "sustaining and accelerating that movement."
Looking ahead, he said, "I'm placing a lot of emphasis on improving and enhancing and growing the various collaborations of the various (government) agencies in healthcare." An estimated 40% of all healthcare in the U.S. is paid for by the government, either through benefits paid to government employees or payments by Medicare, Medicaid and other programs, he said.
But developing synergies among the government healthcare programs, "we can make and have a positive influence on the private sector," he said. For example, Kolodner noted the HHS funded, not-for-profit Certification Commission for Healthcare Information Technology has had a "remarkable impact on the ambulatory arena."
Next week, he said, the Leavitt-appointed healthcare IT advisory panel, the American Health Information Community, will meet to discuss future plans for healthcare IT development.
Work on prototypes of a National Health Information Network under other HHS contracts was unveiled in January, "And now, in May, we'll let the next RFP (requests for proposals) for the trial implementations. That's going out not to the IT companies, but the state and local and regional health information organizations."
Kolodner also said he sees part of his job as explaining the government's various roles in the IT development process, noting "People are a bit confused how all those things fit together."
"The other thing we'll need to be sustaining is the activities with the states," he said. "That's a very important collaboration that we have."
A final report is due this summer from RTI International on work it performed under a $17.23 million contract with the Agency for Healthcare Research and Quality at HHS, work supported by the National Governors Association's Center for Best Practices, that delved into variances in state privacy laws and practices and their impact on the development of healthcare information exchanges. RTI created the Health Information Security and Privacy Collaboration to carry out that work.
Additionally, in October, HHS through ONCHIT, led a $1.99 million contract with the NGA and its research center to establish the State Alliance for e-Health, which may well address some of the same issues raised by the RTI/NGA study. Likely targets are the more-stringent privacy protections in some states than those afforded by the federal privacy rule under the Health Insurance Portability and Accountability Act of 1996. Other targets will also be the many state laws that require laboratories to only send patients' test results to the physicians or other practitioners who ordered the tests. The laws effectively bar laboratories in those states from sending concurrent transmissions to regional health exchanges or individually purchased or insurance-industry sponsored or employer-sponsored personal health records.
Brailer, Kolodner's predecessor, often used the office of the national coordinator as a bully pulpit to proselytize for healthcare IT adoption and expansion. Some of that work has been taken over by HHS Secretary Leavitt and by President Bush, so Kolodner said he sees that as part of his job, but to a lesser degree.
"There is an aspect (of the job) to communicating and helping the country and the various stakeholders understand of the importance of this," Kolodner said. "I would say the key part of this is emphasized by the second part of my title, as coordinator."
Many actors must play their parts in developing an national healthcare IT system, inside government and out.
"This is something that ONC(HIT) isn't going to do on its own," he said.
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