Compared with its predecessor ONC plans in 2004 and 2008, the Blumenthal document is “more comprehensive, particularly in the approach to what's going on in the various federal agencies,” said Tom Leary, senior director of federal affairs for the Chicago-based Healthcare Information and Management Systems Society.
One reason, Leary said, is that ONC's duties and responsibilities were codified by Congress with the Health Information Technology for Economic and Clinical Health Act, a subsection of the American Recovery and Reinvestment Act of 2009. Initially, the ONC, then called ONCHIT, began as an office created by the 2004 executive order of President George W. Bush. It was given a broad mandate to coordinate federal health IT activities, but few specific responsibilities and little money.
“Codification was absolutely critical to the legitimacy of the office,” Leary said. As a result, the latest plan “really emphasizes the coordinator's role,” he said.
Dr. Farzad Mostashari, deputy national coordinator for programs and policy at ONC, explained that in 2008, when the previous plan was released under coordinator Dr. Robert Kolodner, “ONC didn't have the tools, the authorities, the funding, the programs, to really be responsible and accountable for a lot of the aspirational milestones that were there.”
“This time, there are a lot more areas where it is clear what we are actually doing, not what we're hoping for, but what we're actually doing to make it so,” Mostashari said. “The implementation of the HITECH Act and the vision of where we could go given the HITECH authorities really dramatically changed the landscape and provided some new directions for us and the country.”
The latest plan is “ambitious,” according to Chantal Worzala, director of policy for the American Hospital Association. “There is a lot of sort of brave new world in here. I'm looking for reassurance that there is constant evaluation built into this. I want to make sure as we move forward that we touch the ground, that programs are working before we move forward.”
The five goals are that the government will promote the use of health IT to: foster health information exchange; improve care and population health; inspire trust and confidence; empower individuals to improve their health and the healthcare system; and achieve rapid learning and technological advancement.
“We think the five goals are moving things in the right direction,” said Chip Kahn, president of the Federation of American Hospitals. “I don't know enough to say if we're overextending ourselves, but there are two critical paths here: adoption and moving your work processes in a direction that allows for health information exchange,” Kahn said. “I don't know whether we can do it in five years,” he added.
Dr. Harris Stutman, executive director for clinical computing for the 252-bed Saddleback Memorial Medical Center in Laguna Hills, Calif., said he was particularly pleased with the goal targeting learning. “At some point, we're going to do some things really exciting in real time,” said Stutman, one of a group of health IT professionals who periodically advise ONC on various topics, including leveraging computerized clinical decision support systems to improve patient care. “We're going to be able to crunch those numbers and analyze that data and provide really useful feedback to the physicians and nurses to make better decisions and provide better care.”
Dr. Deborah Peel, founder of Austin, Texas,-based Patient Privacy Rights Foundation, said the section aimed at inspiring trust starts strong, asserting that government is obliged to “meet the needs and protect the rights of each individual.” She added, however, that it “fails to live up to this principle” by not giving patients control over their health data.