JASON report
Blumenthal supports the findings of the JASON report “A Robust Health Data Infrastructure,” an April 2014 document prepared for the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services.

“I think that the Jason Architecture that has been proposed now through a report to the Office of the National Coordinator and others seems to be a reasonable way forward,” Blumenthal said, “and I’m confident that, with the pressure now that is growing for interoperability and the demand on the part of people in the market – users of the technology – we will now take that challenge on in a very important and aggressive way. And, that seems to be the way the Office of the National Coordinator and CMS are moving.

The report lists the many benefits of health data exchange:

• Satisfy the growing demand of patients for flexible access to their own health information
• Offer faster, interoperable access to patient records by health care providers
• Reduce errors within individual records and across records
• Reduce redundant testing and diagnostic procedures
• Produce more complete health records and more accurate health data
• Promote better longitudinal tracking of patients and patient groups
• Promote improved standards of care and reduce the incidence of errors in clinical practice
• Provide research data of unprecedented power to inform clinical care, public health, and biomedical research
• Facilitate better communication among health care providers and patients
• Enable electronic detection of health care fraud
• Improve tracking of health care costs and benefits, thereby enhancing understanding of the economics of health care delivery.

“Whether any of these benefits can be realized depends not only on the framework for health information technology and exchange, but also on the details of any such implementation. It is therefore vitally important to get those details right,” the report noted in the executive summary.

“The JASON report builds upon our understanding of the technical, broad policy and privacy and security issues that are both opportunities and challenges as we advance an agenda of meaningful exchange and interoperability,” DeSalvo wrote in her April 16, 2014 blog. We look forward to engaging with our Health IT Policy and Standards Committees, but also across the health care industry, with consumers, providers, employers, purchasers and health IT developers as we evolve our roadmap for interoperability, a robust health IT infrastructure, and a shared set of priorities for our nation.”

Is Stage 2 too hard?
Given the widespread complaints about Stage 2 challenges, could it be that Stage 2 simply just too difficult to accomplish?

“Well, the big difference between the first and second stage is the interoperability and information exchange requirement,” Blumenthal replied. “I think it shows how slow adoption would have been if meaningful use had been defined as accomplishing exchange in the first order. So, I think that, in a sense, what we’re seeing is the rubber hit the road – demand for meaningful use becoming demand for real meaningful use rather than just for data entry. And, that will challenge the healthcare system.”

He added some words of caution in gauging the difficulty of Stage 2.

“You have to factor into the complaints the possibility that there are underlying economic motives for organizations not to exchange information, he said. “It’s always easy to blame the technology when, in fact, what is going on is you don’t want to lose what you view as proprietary information.”

Blumenthal expects pushback – “because we haven’t invested sufficiently in standards development; we don’t have the political will to force compliance and consensus around a set of standards; and we don’t have

“So that’s the political and economic environment in which we are tending to blame the technology and the federal regulations when in fact I think the concern really lies elsewhere,” he said. “I don’t think there is any reason why we couldn’t have interoperability if we were invested in it sufficiently and if we supported it sufficiently and if we empowered government and the private sector to come to rapid agreement on standards.

Blumenthal believes that one of the ways to make transformation of the healthcare system a national priority to by making providers accountable for the quality and cost of care they provide, thereby creating a business case for good information and thereby also making them desperate to know what’s actu

ally going on with their patients – so they don’t duplicate the use of services and they don’t get penalized for underperforming on quality.

“And, then, they will come to the table and push very hard on Congress and the executive branch and on vendors to participate in the standards development activity that is meaningful,” he said.

Blumenthal is seeing the beginning of this, but the efforts are far from perfect.

“Part of what we see is an initial reflex on the part of larger healthcare organizations is to get really good interoperability within their walls and then to fight it outside the walls,” he said. What we haven’t got yet is really meaningful financial accountability for the total cost of care for a patient population, which providers are responsible for.

“The accountable care organization movement is a step in that direction, but it’s still nascent, and it’s still really more about shared savings than it is about risk. And, risk is a lot more motivating than the opportunity for savings.”

As he sees it people who work on the IT side of healthcare, don’t appreciate how much their work is dependent on the financial incentives and culture that prevails in the general healthcare business.

“I think people who assess the performance of electronic health records, also tend to assess them as a stand-alone technology rather than seeing the technology for what it is, which is a tool that business leaders use to accomplish business objectives,” he added. “If the business objective is to maximize billing, electronic health records can be used to do that. If it’s to secure and digitize and retain information, they can be designed to do that. If it’s to exchange information and have a complete picture of the patient as the patient experiences care in the community, it can be used to do that.”