White House names new health IT chief

Washington -- The nation's new health information technology chief, Robert M. Kolodner, MD, will spearhead the federal effort to equip the majority of patients with electronic medical records within a decade of President Bush's establishment of this goal in 2004.

Prior to his appointment, Dr. Kolodner spent nearly 30 years working with the Dept. of Veterans Affairs where he helped develop the department's EMR system, known as VistA. American Medical News spoke with Dr. Kolodner, who had served as interim national health IT coordinator since September, after his appointment to the permanent post on April 18.

What do you hope to accomplish as the national coordinator?

I hope to continue creating the environment where market forces can advance the use and adoption of interoperable health IT across the nation. The reason for it is a fundamental requirement to transform health care in the future and improve the quality, while reducing the cost.

Your predecessor, Dr. Brailer, said that his replacement would need to help physicians implement IT by lowering the cost, raising the economic benefit and lowering the technology's risk. How can this be accomplished?

There are a number of incentives, such as the modifications to the Stark anti-kickback regulations. Those went into effect in October so that larger entities, such as hospitals, can cover the vast majority of the cost of [electronic health records] for individual providers. Pay-for-performance may provide some incentive for using EHRs. We're looking at recommendations that we work with malpractice insurers to lower the rates for physicians who are effectively using electronic health records. People may start choosing their providers based on their ability to use personal health records. Certification will provide a reassurance for physicians that a product achieves a certain level of functionality, security and interoperability.

Will the anti-kickback modifications you've already made be sufficient to promote adoption?

We can accomplish an awful lot with the tools that we have. We will be monitoring to see what progress we make and what uptake we have. We are looking at a suite of activities, knowing that some providers will find some more attractive than others.

So you've seen evidence that hospitals plan to donate health IT to physicians based on these safe harbors?

Yes, I've heard from a number of institutions that they plan to do that and from a number of providers that they look forward to that.

Are we still on track to complete the president's 10-year plan for moving toward a paperless health care world?

We are on track. It's early in the phase, but we're creating a tipping point. There's good evidence that we are being successful. We have had the first set of standards approved. They'll be recognized by the [Dept. of Health and Human Services] secretary at the end of this year, and they'll be used by the federal providers. We'll be building it into our contracts.

With the announcement of the latest set of ambulatory EHRs that are certified, we have well over 25% of the vendors and over 75% of the installed base that now represent certified products. The vendors have really embraced that process, and we believe that the clinicians will see that as a way of reducing their risk.

How will your background as a physician help you?

Having practiced and taken care of patients, I'm grounded in what the focus is -- to help us improve the experience for the individuals and to help providers give better care. I know, having been in the VA and seeing the remarkable change that's occurred in the last 10 years, that health IT was a critical factor in achieving that transformation.

It is impossible to practice medicine at the high level that we all deserve, that we all should be demanding, without the provider having an electronic health record.

What can the rest of the country learn from the VA's experience with EMRs?

The VA is really a laboratory for the nation. When you have an electronic health record that is used universally, when you have bar-coded medications, when you have personal health records, when you have the ability to use telehealth devices and telemedicine -- when you put all of these together, you can achieve remarkable things that patients and physicians appreciate.

Your office has faced accusations that it is not doing enough to ensure the security and privacy of EMRs. How do you respond?

We know privacy, security and protection of the patient's confidentiality is fundamental to us succeeding. In the discussions that I had in hearings, the disagreement wasn't whether something needed to be done. It was over how we needed to go about that.

This is an area where there are differing opinions. Each of the different groups with slightly different opinions would like theirs to be the solution we choose. Getting an agreement, especially when you're doing policy, takes time. We're working on a roadmap. So the issue is not a disagreement on how fundamental it is, it's just some disagreement on what the steps are and whether we should have made faster progress than we have made so far.

Do you have more specific assurances than simply saying you are committed to privacy and security?

One of the concerns on the Hill was that technology is moving so fast that it would be setting policy. We don't intend to have that happen. As we go to release [the request for comments on] the nationwide health information network in the next few weeks, we are going to be [requiring] certain capabilities for patients to be able to manage the way their data flow over the network. The reason is so that the technology does not dictate the policy.

What developments are prompting the most optimism?

The uptake of the certification within the community, both by the vendors and by the providers, has been exceeding our expectations. Some of the activities in the personal health records space have gone at a faster clip than I thought they might. I'm delighted because that area has real potential to empower patients to play an active role in managing their health.

Is there anything else physicians need to know?

The providers I know are practicing medicine because they want to help people. We have been hampered by the lack of information tools in delivering the highest quality care. While the use of [EHRs] in an interoperable environment is something that's new to many, the improvement it can bring about, the higher quality care we can deliver, and the ability for it to help the nation maintain costs overall is tremendous.