The tenure of Dr. David Blumenthal as the third leader of the Office of the National Coordinator for Health Information Technology at HHS from 2009 into 2011 exemplifies the adage, “Be careful what you wish for.”
In January 2009, the Commonwealth Fund published five pages of federal health IT policy recommendations authored by Blumenthal well before he took the top spot at ONC.
One was to create a system of federal incentive payments for EHR adoption and penalties for failure to adopt. Other recommendations called for setting up state and local health IT support organizations, or “geek squads,” to provide technical assistance to providers adopting EHRs; continuing a testing and certification program for EHR systems; and having “some group” anoint a set of standards for health IT system interoperability.
Blumenthal's two predecessors, Dr. David Brailer and Dr. Robert Kolodner, had run the ONC for the first four years of its existence on budgets of about $50 million a year. Then came the Great Recession, triggered by the Wall Street financial collapse in the fall of 2008.
The American Recovery and Reinvestment Act—legislation to combat an economic collapse that rushed through Congress in early 2009 like a downhill freight train—passed just 18 days after its introduction. During the breakneck legislative process, “They added a car to the train” for health IT, Blumenthal recalled.
The multibillion-dollar HITECH bill was drafted, however, without a lot of input from Blumenthal during the revisions of the bill, even though he'd been advising the Obama campaign on healthcare and health IT policy for the prior two years.
A little more than a month after the ARRA was signed into law, Blumenthal was named ONC chief, tasked with carrying out many of its recommendations, which matched many of those on his own wish list for health IT policy.
Despite funds provided by the ARRA, Blumenthal said during two interviews for the 10th anniversary of the ONC, he knew there were no guarantees the many EHR incentives in the massive stimulus law would work.
“There were many times when I didn't know whether we were going to be successful,” Blumenthal said. “There were, obviously, huge risks.”
Follow Joseph Conn on Twitter: @MHJConn
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