The next contracts from HHS to fund development of a national health information network will not so much go to vendors of products and services that could be used by regional health information networks, but more to state and local RHIOs themselves, according to a federal official speaking at the Healthcare Information and Management Systems Society meeting last week in New Orleans.
The man in charge of IT coordination at HHS, Robert Kolodner, also said the nation is on track to make good on a Bush administration goal of making electronic health records widely available by 2014.
In late 2005, HHS agreed to pay $18.6 million to four consortia of healthcare systems integrators, consultants, software developers, RHIOs and end-users to come up with prototypes of a future NHIN. The four consortia, headed by Accenture, Computer Sciences Corp., IBM Corp. and Northrop Grumman Corp., delivered their proposals in January to the American Health Information Community, HHS Secretary Mike Leavitt's IT advisory panel.
The next round of contracts will focus on applying whats been learned in the first round of prototype contracts, as opposed to focusing on architecture, according to John Loonsk, the director of the office of interoperability and standards at HHS' Office of the National Coordinator for Health Information Technology.
Loonsk's remarks came during a sometimes spirited conference session Feb. 27 billed as a "town hall" meeting with a panel of ONCHIT's top brass.
"As the NHIN progresses, were going to engage state and regional health information networks directly," Loonsk said. "We have to work on the interfaces between these systems. One of the works of the NHIN prototypes is to identify the ways that the systems have to interface in the future."
Loonsk said the government will contract with the Gartner Group, an IT consulting firm, to work on the interfaces. After that, Loonsk said, "Trial implementations are the next step and they will embody much of the progress that has been made" on the NHIN prototypes.
Kolodner, the interim national coordinator for health information technology, was asked during a question-and-answer session whether the goal set by President Bush in 2004 to have electronic health records available to most Americans by 2014 was achievable, given the slow progress thus far.
"It's a tipping point," said Kolodner, a psychiatrist and the former head of healthcare IT at the Veterans Health Administration. "It's not linear growth. We'll make it in 10 years. Most Americans will have electronic medical records that the providers will be using. One of the interesting things is whether personal health records will drive the adoption of electronic health records."
Members of the ONCHIT panel were asked whether IT would help alleviate healthcare disparities.
Karen Bell, physician director of the office of health IT adoption at ONCHIT, said it is too soon to tell.
"It is a difficult question," Bell said. "We have not reached a level where the benefits of HIT are available to many people at all. We have yet to prove that this will address the disparities, but we believe if we can provide better care for everyone, we can over time provide better care for the underserved."
Jodi Daniel, director of the office of policy and research at ONCHIT, reaffirmed what Bell had said at an earlier conference session, that the Internal Revenue Service should soon issue guidance on gifts of healthcare IT software, training and support to affiliated physicians.
The American Hospital Association has asked the IRS for the guidance so hospitals might avail themselves of exemptions and safe harbors from Stark and anti-kickback laws issued by HHS in August 2006 to promote IT support for office-based physicians.
"The IRS is fast-tracking it now," Daniel said. "We're hoping its a matter of months, but I can't speak for the IRS."
Audience member and healthcare IT consultant Gary Dickinson spoke critically of HHS' process, saying the members of the federally-sponsored American Health Information Community and its work groups were appointed by Leavitt, thus their ranks were closed to the general public, and one of the open committees, the Healthcare Information Technology Standards Panel, focused on specific-use cases chosen by AHIC.
"We were told that we were precluded from talking about privacy and security," Dickinson said. "It's unclear to me what we're building, other than some fanciful things, other than we want to solve this or solve that, but were not sitting down to build the foundation. As it stands the foundation for privacy and security is an afterthought."
Both Loonsk and Kolodner spoke in disagreement, noting that the AHIC had set federal priorities and tasked its work groups with addressing those priorities first.
In an e-mail, HITSP Chairman John Halamka said his panel has developed "a highly structured (nine)-month plan for security standards harmonization," adding that Dickinson is a member of a HITSP "foundations committee" that is working on "the longer term strategic issues he mentioned."
But the very structure of the 17-member AHICco-chaired by Leavitt and Kolodneralso was targeted from the floor by Al Kinel, director of Alliances Health Group at Eastman Kodak. Kinel wondered aloud how people outside of the AHIC could influence the group when it sets priorities for the federal IT promotional effort.
"Medical imaging is a critical part of the medical record," Kinel said, but, "we haven't yet found a way to prioritize that. The prioritization process itself is so difficult. There is no road map there. I dont even see it on the table. What do we have to do ... to make it one of the things that we look at in 2008?"
Kolodner responded that, when setting the national IT agenda, "Certainly, there are a lot of No. 1 priorities. We acknowledge that no process is perfect. It is maturing and will be transitioning into the private sector. I suggest there are advocates that (will) put that (imaging) on the table."
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