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Dr. Karen DeSalvo

ONC leaders examine role of government in health IT

By Joseph Conn
Posted: February 26, 2014 - 4:15 pm ET

Three former heads of the Office of the National Coordinator for Health Information Technology plus its current leader appeared on one panel at the Healthcare Information and Management Systems Society convention Wednesday, sharing their thoughts on health IT's history and future and the role government should play in it.

The government can help the industry set goals, said Dr. Farzad Mostashari, now a visiting fellow at the Brookings Institution, a Washington think tank, who stepped down as the fourth ONC leader in October. The ONC chief can use that “bully pulpit” to ensure it remains focused on them. The government also should use the market to achieve national goals, “but the corollary is, if markets fail,” and providers enter into anti-competitive behavior, then the government has a role through the Federal Trade Commission “to make sure the market works the way it's supposed to,” he said.

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The FTC has set hearings March 20-21 on EHRs and how they could be used to create non-competitive behavior,” Mostashari noted. One role of the ONC “is to make sure the regulators are well informed on what we're doing in health IT,” he said.

Government needs to provide “the broad view” to ensure the interests of individuals and communities are addressed, said Dr. Robert Kolodner, the second and longest-serving leader of the ONC.

“There are times when the customer has to drive the marketplace,” said Kolodner, now vice president and CMO of ViTel Net, a McLean, Va., provider of telehealth software and services. “Each of the vendors wants to maximize the markets they have.” The federal government, pouring $19.2 billion thus far into the EHR incentive program under the American Recovery and Reinvestment Act of 2009, has distorted the market, the ONC chiefs agreed. Now that the federal incentive money is running out, the consumer will re-assume control of the market, Kolodner said.

“It's a question of when that sleeping giant will awaken,” he said.

His view on the appropriate role of government in health IT has evolved since he became the first ONC head in 2004, said Dr. David Brailer, a former health IT entrepreneur, now the CEO of Health Evolution Partners, a San Francisco-based private equity firm.

He assumed the ONC would sunset after 10 years, Brailer said, the time President Bush allotted for achieving his goal, also set in 2004, of providing every American access to an electronic medical record.

“I've come around on that,” Brailer said. “I think it could provide an enormously beneficial function synchronizing things across different (federal) agencies.” Without it, the government risks reverting to “a tower of Babel” with many agencies sending differing messages on where health IT should go.”

The ONC, created by executive order of then-President George Bush in 2004, will mark its 10th anniversary in April. All of its leaders except the nation's third national coordinator, Dr. David Blumenthal, were gathered by HIMSS to take a look at health IT history and its future during a panel discussion at the Chicago-based trade group's annual convention in Orlando, Fla.

Consumer oriented digital health tools such as FitBit, gathering and submitting patient-generated data will be part of that awakening, said Dr. Karen DeSalvo, national coordinator for health IT.

“We don't have ways to receive it very well, but I think people are really willing to quantify their health,” she said. Government needs to make sure access to the benefits of health IT is open to all, DeSalvo said, to “make sure no one is left behind.”

Follow Joseph Conn on Twitter: @MHJConn

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