HHS Secretary Mike Leavitt says that he hopes to find the modern-day equivalent of the founding fathers to run a successor to the American Health Information Community, which is charged with advising the government on how to implement electronic records in healthcare. But critics say the new AHIC is more likely to end up with leadership that gives short shrift to the needs of the people.
Leavitts comments came at a public forum Aug. 17, when he said he was looking for a person or organization to be a modern-day George Washington and serve as a convener of stature to call together another group of founding fathers to be the architects of what he called AHIC 2.0. We need to bring the James Madisons and the Alexander Hamiltons of the world together, Leavitt said. Can we create a George Washington here? If we could even have two or three organizations step up, that would be OK.
The effort by HHS to convert AHIC into a private group moved forward recently, with a formal request for grant proposals being published Aug. 13. The proposal allocates $13 million to support an AHIC successor organization for two years. The grant winner will convene a planning board; design and establish the AHIC successor governance, business and operating models; and elicit members such that the resulting organization is a balanced, effective, public-private collaboration of organizations and individuals in all sectors of the health community.
HHS unveiled the idea in June (June 18, p. 12), attracting quick criticism from Rep. Pete Stark, (D-Calif.). And the recent forum led to additional critiques. That George Washington is going to be a tough role to fill, and my guess is its going to be empty, said Brent Gendleman, president and chief executive officer of 5am Solutions, a Reston, Va.-based consulting and software development company working with the life sciences industry, in a telephone interview. The government has a greater role, which I think theyre shirking, by saying, Let the market push us. No. The market led us here, and if you just let the market do it, youre not going to get the results you want. I realize that is a philosophical difference, especially with this administration. But government has to play a role bigger than the one that theyre envisioning.
Yeah, Im a CEO. I encourage business, and I think there will be plenty of business, but its different when youre talking about something that supports the common good, Gendleman added.
Gendleman noted during the forum that he fears that the small patient-advocate organizations are not going to have the right kind of seats at the table.
Others raised the argument that a nongovernmental AHIC would reduce the voice of the patient. Sabrina Corlette, director of health policy programs at the National Partnership for Women & Families, picked up on the analogy of the Constitutional Convention, noting that there were huge swaths of people who were not represented, and as a result we had huge upheavals such as the Civil War and the equal-rights movement.
Ensuring that all interests are represented in the new AHIC will be a challenge, Corlette said. One problem that consumers and consumer groups have is they dont have the resources to stay engaged, she said. The highly technical issues that will be discussed, the thin staffs of many of the not-for-profit groups, and the dues to the successor AHIC that are being proposed to make the new organization self-sustaining pose huge problems for consumer groups, local public health organizations and local governments, Corlette said.
Similarly, the AARP laid out its case against the change in an Aug. 10 letter to Leavitt written by David Sloane, the AARPs senior managing director for government relations and advocacy. He wrote that the proposed new AHIC lacks essential public oversight and accountability.
Developing consensus on key policy issues for the national network, including privacy and security issues, must be addressed in order to ensure that consumers have confidence that the network will not compromise their own sensitive personal health records, Sloane wrote. The pivotal and sensitive nature of this task requires a strong, inclusive, open and accountable decisionmaking body. The business models suggested to replace AHIC would not meet this requirement. In fact, we believe AHICs current structure needs to be strengthened as it would be under the AARP-endorsed bipartisan Senate Wired for Health Care Act (S. 1693).
Additionally, he wrote that: Replacing AHIC with an entity that is governed and operated without federal oversight would have serious shortcomings, which include: no assurance of inclusion of all stakeholders or transparency in operations; no assurance that funding for the entity does not create potential conflicts of interest; and no clear accountability to Congress or the public at large.
Others participating in the recent forum pointed to the difficulties AHIC might face with a change in leadership. Todd Smith, director of the strategic action group at the American Health Care Association, said that members of the new AHIC might want to stray from the path set for them by the current AHIC, but would be constrained by the work already in the pipeline, he said.
While Leavitt noted the two organizations will run in tandem at first, the exiting AHIC has a full agenda that he wont abandon, but rather hopes to drive that as far and as fast as we can. So, the successor organization will be inheriting that agenda, which Leavitt sees as a good thing. Leavitt said the government wont be completely withdrawn from the successor organization or its goals.