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Monday, March 28, 2011

What's New in the ONC Strategic Plan for HealthIT

I'm suffering from a Spring cold, so it's difficult to focus today.  I started the day off trying to read through the 80 page Health IT Five-year Strategic Plan from ONC.  The plan was last updated in 2008 by the ONC in the Bush Whitehouse.  If you are looking for a summary of the new plan, check out John Halamka's post.

Whenever a plan changes, the first thing I want to know is what's different, and the second is why.  So I put together this little table which shows the what.  I'll save the why for when I'm a little more coherent.  The first column for 2008 shows the eight objectives from the 2008 plan.  The second column shows the matching goals from the 2011 plan.

Objective 1.1: Facilitate electronic exchange, access, and use of electronic health information, while protecting the privacy and security of patients’ health information  Goal I, “Achieve Adoption and Information Exchange through Meaningful Use of Health IT” discusses the centerpiece of the government’s health IT strategy over the next five years. “Meaningful use” is aimed at widespread adoption and information exchange in its first two stages, and will then build to improved health outcomes in the third stage. Activities are focused on two areas: defining the meaningful use of certified EHR technology, and encouraging the achievement of meaningful use through the Medicare and Medicaid EHR Incentive Programs and supporting achievement of meaningful use through grant programs, including information exchange with public health department and laboratories.
Objective 1.2: Enable the movement of electronic health information to support patients’ health and care needs 
Objective 1.3:  Promote nationwide deployment of EHRs and PHRs and other consumer health IT tools 
Objective 1.4:  Establish mechanisms for multi-stakeholder priority-setting and decision-making
Objective 2.1:  Advance privacy and security policies, principles, procedures, and protections for information access in population health  Goal III, “Inspire Confidence and Trust in Health IT,” focuses on government efforts to update its approach to privacy and security issues related to health IT, and build greater confidence and trust in EHRs and health information exchange among providers and the public. The digitization of health records will create a new set of challenges for protecting the privacy and security of health information, but it will also open new opportunities for improving safeguards.
Objective 2.2: Enable exchange of health information to support population-oriented uses  Goal II, “Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT,” discusses the specific ways health IT is contributing to the goals of health care reform: improved care, improved population health, and reduced per capita costs of health care. Widespread adoption of EHRs, information exchange, quality improvement initiatives, and health care reform pilots are required to implement the Affordable Care Act. As part of each of those activities, the government is investing in and leveraging health IT to create a transformed health care system.
Objective 2.3:  Promote nationwide adoption of technologies to improve population  and individual health 
Objective 2.4: Establish coordinated organizational processes supporting information use for population health 
Goal IV, “Empower Individuals with Health IT to Improve their Health and the Health Care System,” discusses how the government is designing health IT policies and programs to meet individual needs and expectations, provide individuals with access to their information, help facilitate a strong consumer health IT market, and better integrate individuals and clinicians’ communications through health IT. A public that has a voice in designing national health IT policies and programs and is empowered with access to its health information through useful tools can be a powerful driver in moving toward patient-centered health care.
Goal V, “Achieve Rapid Learning and Technological Advancement,” focuses on demonstrating ways health IT and meaningful use can enable innovation and appropriate use of health information to improve knowledge about health care across populations. In the long run, the government is pursuing a vision of a learning health system, in which a vast array of health care data can be appropriately aggregated, analyzed, and leveraged using real-time algorithms and functions. This future will require technical innovation to build on the foundation of meaningful use, as well as finding new ways to use that foundation in the practice of health care.

What's new?  

The HITECH Act has created a completely different environment for change that supports the first two goals quite well through incentives, grants and other programs.  As I read through the 2011 plan, I find that many of the tactics being used to advance the strategic goals, especially around Goal I are well into the execution phase.  I still think communications could be vastly improved.  It still amazes me how many providers have never heard of meaningful use.  The Government has never been good at marketing, but it needs to get better if Meaningful Use is to succeed.

Goal II still needs some work on the public health side.  The HITECH Act doesn't provide much for public health in the way of assistance, but requires providers to work with public health.  Something needs to close that gap.

Goal III needs much more communication and time.  Trust will happen eventually.  Remember when you wouldn't enter your credit card number on the Internet? Well, those days are gone, but that didn't happen overnight.

Goals IV and V are more in the future.  Individual empowerment has begun.  While some are concerned that less than 10% of American's are using a PHR, I'm absolutely thrilled that 1 in 15 have and that number is growing.  It is clearly an emerging market.  I expect those numbers to double or triple in the next few years. It's pretty clear that Rapid Learning will occur as more data becomes available.  I signed up for 23 and Me about a year ago and the number of new results that I've seen over the past year has been astonishing (even if not all that useful yet).  I expect similar things to happen elsewhere.  The really interesting challenge could come from patients who want a piece of the action


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