Leavitt plans to walk away after not quite six years on the job, heading an organization whose original mission was to help boost adoption of electronic health-record systems, which has been largely an uphill slog without government subsidies.
He'll leave just as federal floodgates open on an estimated $34 billion in federal IT subsidy payments to healthcare providers under the American Recovery and Reinvestment Act of 2009. But leave he will.
“It's really a promise I made to my family and myself when I took on the CCHIT role in 2004,” Leavitt said in telephone interview. “I wanted to see the organization through the big changes in ARRA. The window was coming up, so I let the trustees know.”
“I am retiring,” he said, but not fully. “I'm not planning to take on another full-time position instead. I'm not going to lie around on the beach. I'm not going to play golf, because I never learned to play golf. It's kind of a re-invention of how I'll spend my time. But it's really important to keep promises to our families. I'm excited about it.”
Leavitt said he's been through reinventions before in a career that began with him programming mainframe computers.
“My first career was as an electrical engineer,” he said. He earned a bachelor's degree in electrical engineering from the University of Arizona in his home state.
“I designed reconnaissance systems for defense purposes,” Leavitt said, working for Electromagnetic Systems Laboratory, Falls Church, Va., an intelligence and defense technology contractor that developed satellite, radar and signals monitoring systems. The company was founded by William Perry, another engineer who went on to become undersecretary of defense for research and engineering under President Jimmy Carter and secretary of defense for President Bill Clinton.
During his six years at ESL, Leavitt earned master's and doctoral degrees in electronics from Stanford University.
Leavitt added a second professional layer, that of physician, to his engineering training, attending the University of Miami Miller School of Medicine and the Oregon Health and Science University, and practicing internal medicine for 10 years.
“I wrote my first electronic medical record in 1982 on an Apple II Plus and floppy disks,” Leavitt recalled. The idea, he said, was to start his medical practice not using paper records. He incorporated MedicaLogic, Hillsboro, Ore., one of the pioneering EHR developers, in 1985 and hired his first employee in 1990.
“I gave up professional practice in 1992 on my 10-year cycle because MedicaLogic was taking off,” he said. Leavitt took MedicaLogic public in 1999 and merged it with physicians' and consumers' Web portal-developer Medscape in 2000. As the dot-com bubble burst, the combined companies filed for bankruptcy protection in 2002 with the assets of Medscape being sold to WebMD and those of MedicaLogic to General Electric Co.
Leavitt worked at GE for “a couple of years” and served as chief medical officer for the Healthcare Information and Management Systems Society, or HIMSS, when President George W. Bush issued an executive order in 2004, creating the Office of the National Coordinator for Health Information Technology at HHS. But Bush specifically required that HHS open the office without additional federal funding.
The first ONC head, a fellow physician and computer entrepreneur, David Brailer, emphasized a market approach to IT adoption. Brailer called for the creation of an independent, private-sector organization that would test and certify EHR systems, sort of an Underwriter's Laboratory for EHRs. Such a system, Brailer explained, would help boost EHR adoption by office-based physicians by overcoming their fears of investing in what, at the time, were untested systems.
HIMSS and two other Chicago-based organizations, the American Health Information Management Association, the trade group for medical records professionals, and the now-defunct National Alliance for Health Information Technology, ponied up the startup funds to launch CCHIT in 2004. In 2005, HHS signed a three-year, $7.5-million contract with CCHIT to provide testing and certification services. The organization has since expanded its programs to include in-patient EHRs and systems for various medical specialties.
“CCHIT was organized in response to the strategic framework that was published within 90 days of his (Brailer's) taking office,” Leavitt said. “That would be the catalyst for the formation of CCHIT. At that time, no one had talked about a government contract. Next year, in the spring of 2005, this RFP (request for proposals) came out to offer a contract for a pilot to certification. That was awarded in October.”
“The very first driver he talked about was ambulatory care, was practice in small offices, and these doctors took the risk on their own and he wanted to mitigate that risk through certification,” Leavitt said. “I think we did reduce risk.”
While CCHIT was not specifically named in the stimulus law, it did require that only certified EHRs would qualify for federal reimbursements, which Leavitt says he sees as validation for the CCHIT program.
“I'm proud of the fact that it was a mission-driven volunteer organization,” Leavitt said. “I've never led one of those before, but people were driven because they wanted to see the vision of healthcare IT realized. I think we've had a very definite impact in a positive way on healthcare IT adoption.
“It's been incredibly educational for me and rewarding—not financially rewarding, it still is a not-for-profit—but it has been rewarding in all other aspects,” Leavitt said.
The stimulus law with its whopping subsidies for EHR adoption was a surprise.
“I think our wildest dreams were exceeded in ARRA,” he said. “That changed the entire environment to one that is basically more political, and on the national agenda. There will be more challenges as the law is rolled out, but we're well prepared for that. I think the organization is well prepared to go on to greater things.”
So too is he, Leavitt said.
“When I go through these changes, I draw on all the knowledge” from prior activities, Leavitt said. “Whatever I do next, I won't discard the knowledge. And, again, I always will add something new. It will be interesting for me. I'll be in the middle of it.”
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