SAN FRANCISCO - After giving the keynote speech at last week's Health 2.0 conference in San Francisco, U.S. Chief Technology Officer Aneesh Chopra sat down with iHealthBeat to discuss how health 2.0 aligns with the Obama administration's larger health reform goals, the federal stimulus package, the administration's open government initiative and shareable intellectual property. The transcript of the interview follows.
iHealthBeat: How did your experience as Virginia's secretary of technology prepare you for your new role as the country's first chief technology officer?
Chopra: Virginia was the first state in the country to establish a cabinet position focused on technology. By serving as the fourth [secretary of technology], I had exposure to what a new role would mean from the existing agencies of government, as well as where we could find the most value. I had the honor and privilege of serving on the [Obama] transition team, which worked to help define the role that I now serve in. So, I think the experiences in Virginia were extraordinarily helpful in determining how and in what manner a federal chief technology officer could support the president's agenda.
iHealthBeat: How does health 2.0 align with the Obama administration's larger health reform goals?
Chopra: Health 2.0 is a key pillar of where we believe innovation will take place in the nation's health care system. As we look to shape the market conditions -- the incentives to reward wellness and prevention -- I have great confidence that the health 2.0 community will rise up to the challenge and engineer game-changing ideas to deliver the results our policymakers in Washington are keen to deliver.
iHealthBeat: What would you say to health care providers who are reluctant to embrace these health 2.0 technologies?
Chopra: I understand and can sympathize with their lot in the current environment that does not reward them for the adoption of these capabilities, but I hope as we proceed with health reform that the stakeholders -- mainly the hospitals and physician groups -- will be very active participants in delivering health 2.0 only because it's in the best interest of the patient.
iHealthBeat: Shifting to the stimulus package for a moment, do you think the Medicare and Medicaid incentive payments will be enough to persuade doctors to transition to electronic health records?
Chopra: We certainly hope so. However, the question presumes the market as it is today, and in that context, it's a 50-50 proposition for physicians who may or may not see the value in the adoption of current technology. But as we proceed in the definition of "meaningful use," focus on health outcomes improvements and inspire the market to build better apps to achieve health outcomes improvements, we are confident physicians might participate without a great deal of long-term incentive payments because it will be a part of health reform and the way we practice medicine in the future.
iHealthBeat: Does the administration have a plan to measure the success of the incentive payments while they are being paid out?
Chopra: Absolutely. President Obama is committed to a government that works. He said so in the Inauguration. He's called for myself, the chief information officer and our chief performance officer at [the Office of Management and Budget] to ensure that we have a culture of performance excellence in Washington, and we are working very closely with David Blumenthal, the national coordinator for health IT, to define outcomes goals that will be used to measure progress. And, again, we're hopeful that when the meaningful use regulations are published, it will be readily apparent what those very specific outcomes goals are and should be.
iHealthBeat: You were involved with creating Apps.gov. Do you see EHRs moving toward a cloud computing model?
Chopra: I think it's inevitable that software in general will migrate to more efficient platforms. As we look to our Apps.gov strategy, we are putting our toe in the water on how to introduce emerging technology into the operation of government and in so doing are hopeful that it might be a catalyst for private-sector action. I see a wide range of applications -- predominately in the physician's office and perhaps at the patient engagement level -- where hosted or cloud-based solutions make the most economic sense to the extent that we address patient privacy and security concerns, which are real and require a great deal of attention.
iHealthBeat: How does the Obama administration's open government initiative align with its health IT goals? Will you push for more collaboration in health IT?
Chopra: Oh, absolutely. It's hand in glove. The open government initiative has three basic pillars.
One is transparency. To the extent that there's information that we have that if made more accessible could enable health outcomes improvement, we're all over it.
Two, it involves participatory democracy to the extent that we are making rules and regulations, not just on health IT payments, but on general conditions. If FDA were to regulate medical devices that impact some of the tools that are enabled through health 2.0, we want to be open and transparent and engage the American people so their voice is heard in Washington without the need to hire a lobbyist or have an otherwise official presence in D.C. So, on participatory democracy, we see great potential.
And, third, we are very bullish on the pillar of collaboration. That is to say, we understand for us to deliver the kind of game-changing improvements in the nation's health care system, there may be a role for the federal government, but it will largely be born out of private and not-for-profit sectors. So collaboration is critical. And, again, we hope to demonstrate that not just in words but in deeds in the coming weeks and months.
iHealthBeat: What kind of role do you see open-source software having in the future of health IT?
Chopra: I think there is a role for a number of technologies, but I am not in favor of open source at the expense of proprietary tools. I actually believe more fundamentally in the principle of shareable intellectual property.
The story that I use is that I am more than happy to buy Microsoft Excel. If I choose to build an app that helps me calculate what mortgage I can afford, [and then] I choose to share that with my neighbor without having to have my neighbor reinvent the wheel, we've created value through the sharing of intellectual property enabled by a system that is at its core a strong and vibrant proprietary platform.
Look at salesforce.com and its app exchange. We see a great deal of value to unlock if we can create more shareable intellectual property.
In health care, if I build a template on a particular EHR that helps me as a provider intervene in a more timely and cost-effective manner, I would hope that template could be very easily shared with others who may or may not be on the same exact EHR but can demonstrate the value of what we were to introduce.
So I'm much more interested in the shareability of intellectual property where appropriate than I am whether its underlying architecture itself is open source or proprietary.