As the many activities mandated by the HITECH Act move forward, I want to take a moment to share my vision of the overarching goal and some of its implications.  Our goal, above all else, is to make care better for patients, and to make it patient-centered.  Information policy and health IT policy should serve that goal.

A key premise: information should follow the patient, and artificial obstacles – technical, business related, bureaucratic – should not get in the way.  As a doctor, I have many times wanted access to data that I knew were buried in the computers or paper records of another health system across town.  Neither my care nor my patients were well served in those instances.  That is what we must get beyond.  That is the goal we will pursue, and it will inform all our policy choices now and going forward.  This means that information exchange must cross institutional and business boundaries.  Because that is what patients need.  Exchange within business groups will not be sufficient – the goal is to have information flow seamlessly and effortlessly to every nook and cranny of our health system, when and where it is needed, just like the blood within our arteries and veins meets our bodies’ vital needs.

If we are to reap the benefit of information exchange, Americans must also be assured that the most advanced technology and proven business practices will be employed to secure the privacy and security of their personal health information, both within and across electronic systems, and that persons and organizations who hold personal health data are trustworthy custodians of the information.  We must have comprehensive, clear, and sustainable policies that strengthen existing protections, fill gaps as they emerge, fortify new opportunities for patients’ access to and control of their information, and align with evolving technologies.  I will devote a separate letter to this critical issue and the many activities mandated by the HITECH Act that we are developing.
On the question of exchange, however, the HITECH Act is pretty specific about eliminating inappropriate barriers.

It squarely tackles the commercial barriers.  The HITECH Act calls for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…promotes a more effective marketplace, greater competition…[and] increased consumer choice” among other goals.  (Section 3001(b))  This means we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries.  Some of these arrangements may improve care for those inside their walls.  But ultimately, they have the potential to carve the nation up into disconnected silos of information, and thus, to undermine the vision of a secure, interoperable, nationwide health information infrastructure, which the law requires us to establish.  Consumers, patients and their caretakers should never feel locked into a single health system or exchange arrangement because it does not permit or encourage the sharing of information.

It tackles the economic barriers.  The HITECH Act incentives for providers and hospitals are powerful tools.  While the official definition of “Meaningful Use” won’t be finalized until next year, the HITECH Act specifically highlights “information exchange” as one requirement for the incentives.

It tackles the technical barriers.  The HITECH Act focuses on “interoperability” or “interoperable products.”  In plain English, this means that our policies, programs, and incentives must aim for electronic health record (EHR) software and systems that can share information with different EHRs and networks so that information can follow patients wherever they go.  And to build the pipelines to carry this information, HHS is directed to invest in the infrastructure to “support the nationwide electronic exchange and use of health information …including connecting health information exchanges…”  (Section 3011)  This means we will work with all our partners in the health and IT industries and with organizations that are committed to information sharing to develop the technologies and policies that can help us deliver information securely, privately, and accurately to whomever needs to see it on behalf of the patient’s health.  We must ensure interoperability for the future.

It provides building blocks for information exchange across jurisdictions.  The grants for states and state-designated entities in Section 3013 – which will total $564 million – target information exchange across boundaries, not only within each state but explicitly as part of a nationwide framework.  We will start announcing the awards this winter.  These grantees’ activities must support interoperability that lets patient data follow the patient across political and geographic boundaries.  The grantees will be our partners in building the nationwide infrastructure mentioned previously.

In short, the HITECH Act not only authorizes but requires us to mobilize all our policies, programs, and incentives to give the American people the patient-centric care they deserve and expect.

I look forward to engaging all our partners in this unique opportunity.

Regards,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services