SAN FRANCISCO – If any of the 2,000-plus attendees of the American Medical Informatics Association annual symposium were hoping for a little preview of what to expect when the federal government unveils its definition of "meaningful use" next month, they didn't get it from David Blumenthal.
What they did get from the country's national coordinator of health IT during his keynote address Monday was a vote of confidence and his assurance that big changes are just around the corner.
"We're going to see major, major changes in the near future -- positive changes. And in many ways, we have you in this room to thank for them. You all saw the future way in the past," Blumenthal told a standing room-only crowd.
Blumenthal gave an overview of HHS' and CMS' strategy to spearhead the creation and deployment of a nationwide interoperable health IT infrastructure spelled out in the HITECH portion of the American Recovery and Reinvestment Act. There is money included in that bill -- about $19 billion -- to encourage the use of electronic health records. The money will go to health care providers who can demonstrate meaningful use of health IT.
While he admitted that "some of the most important content of the new legislation is embedded in those two words -- meaningful use," Blumenthal said he wasn't able to get into details, yet.
First Regional Extension Center Grants Coming Soon
The federal stimulus package also gave Blumenthal's office about $2 billion to encourage the use of EHRs. He described plans to spend about $700 million to develop a network of up to 70 regional extension centers across the country to help physicians and other providers learn to use EHRs.
"Hands-on, at-the-elbow assistance is often what's necessary," Blumenthal said, adding, "We believe it's the best way to start this process for the exchange of information. That's what these regional centers are all about."
Blumenthal said the regional centers will be geared to work closely with state governments and agencies.
"States play a critical role in this. They are well positioned to see where information exchange is working and where it's not. States are also important repositories of data through Medicaid," Blumenthal said.
Blumenthal noted that the federal government would be careful not to micro-manage regional centers.
"This is going to be a complicated process, creating these exchanges in local communities. Our goal is not to predict what solution is the right solution," Blumenthal said.
Blumenthal said his office expects to announce the first grants in the regional extension program "very soon."
Money 'Not Most Important Driver'
"There's a need for government to play a leadership role in promoting changes," Blumenthal said. The money in ARRA will help do that, but it's just the beginning, Blumenthal said.
"I am one who believes that it is not actually money that turns out to be the most important driver. There are other forces -- forces other than market forces – that will be most important in this fundamental change we see beginning now," he said, adding, "I think professionalism and the desire to provide the best medical care will be a powerful force."
Blumenthal said EHRs will soon become standard equipment for health care providers. He said it was hard to understand why it hasn't already happened.
"The idea that we can be technically competent and not be using health IT defies fundamental logic. I think it will be only a short time before EHRs -- or their next incarnation -- will be synonymous with professionalism," Blumenthal said.
He predicted that having and using an EHR will be like having and using a stethoscope, electrocardiograms and MRIs, -- an assumed part of a professional's practice.
"I think we're already moving in that direction and I think we'll eventually come to the point that the idea that the government should be buying their stethoscopes will be foreign," he said.
Blumenthal's Primary Care Roots
Blumenthal admitted that he did not come to the health IT arena by way of informatics but that he owed a debt of gratitude to those who did.
"I came to health IT as a primary care physician and in this room I'm surrounded by friends and colleagues. Much of what I know about health IT and about informatics I learned from people sitting in this room," Blumenthal said.
He told of his IT initiation as a practicing physician at Massachusetts General Hospital.
"I came into my office and found an EHR on my desk. Being of a certain age and being not particularly technical -- you could talk to my wife -- I wasn't sure what to do with it. But watching some of my junior colleagues and not wanting to be left behind, I jumped in and after a while I began to see that it was making me a better physician. And that's what this is all about. It's not the technology that's important but its effects," Blumenthal said.
Education, New Work Force Needed
Government must play a key role in the development and expansion of a new work force, steeped in health IT, Blumenthal said.
"There is a shortage of trained personnel. We will be developing and announcing programs to increase that work force with some very specific needs," Blumenthal said, adding, "These are not the skills that our teenage children have. It's going to be a great challenge to develop this work force because these people will be training for duties well beyond the installation of technology. These people will be a resource of tremendous importance."
And to prove education is a two-way street, ONC placed three large white boards in its showroom booth and invited input.
"Tell us what you think. We want your ideas," ONC's boards invited.
Strategically centered between the educational section and the commercial section of the AMIA Innovation and Information Center showroom, ONC's booth was fittingly at a crossroads and one of the focal points of the expansive showroom.
"This is way bigger and more prominent than any government booth I've ever seen at one of these events," said one AMIA veteran.