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Debate on Feds HIT Policies Continues

by John Moore | August 25, 2008

Last week I put up a post with a quick reflection on the three papers published in the most recent issue of Health Affairs.  The lead paper by Carol Diamond of the Markle Foundation and Clay Shirky of NYU created quite a stir in HIT policy circles that continues to motivate others to express their thoughts.

On August 19th, Mark Leavitt, the head of CCHIT chimed in with his own thoughts on the topic, which not too surprisingly were in glowing support of the feds efforts to date (feds formed and funded CCHIT to certify EMR solutions).  One need only read the title of his post in the Health Affairs blog, HIT Initiatives, Not Magical, Just Practical, clearly giving a little dig to the “magical” reference in the Diamond-Shirky article to know where he stands.

Then on August 20th another post went up on the Health Affairs blog, this time from the AHIC Consumer Empowerment Workgroup chairwoman, Nancy Davenport-Ennis.  In her post, Speaking for Consumers on HIT, she speaks glowingly of all the great initiatives that the feds have done to date and her organization (Patient Advocate Foundation – PAF) firmly supports.  Whole post comes across as almost a blind allegiance to the feds and their policies to date.   One particular example was the statement:

We have come incredibly far in just the past few years in health IT development and adoption — looking to the successes in local regional health information organizations (RHIOs), the development of community-level public-private partnerships, and a recent Medicare demonstration in selected communities providing financial incentives to primary care physician practices using certified EHRs to improve quality, among others — and we should be proud of this progress.

Now I know Nancy means well, but really, almost without exception, RHIOs have failed to create a sustainable business model and are failing; community-level partnerships are all over the map in terms of relative success (I’ve yet to see a good paper stating otherwise but if someone knows of one, please push it my way), and as for the Medicare demonstration, well I have heard plenty of push-back so I’m not convinced that this working out as well as some would like you to believe.

Finally, Esther Dyson, someone who has been around the block more than a couple of times following Internet development trends, weighs in on August 21 with her own post, Health IT: Intelligent Evolution. While I differ with her on referring to the evolution that is occurring as “Intelligent” and feel she completely misses the boat on what a huge challenge it will be to first get health data into a digital form factor (getting the other 80%+ of physicians to adopt HIT) that consumers can then leverage and the even bigger problem of just getting the consumer engaged, I do agree with her core thesis that much of the future evolution of health IT will be directed at and driven by the consumer.

Actually, I could not agree more with this view as I came to the exact same conclusion nearly a year ago which led to the founding of Chilmark Research.  I hope that on this point we will be proven correct.

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