One of the eHealth 2010 sessions that I looked forward to the most was a panel discussion with Dr. David Blumenthal, Director of the U.S. Office of the National Coordinator (ONC) for Health IT, and Mr. Richard Alvarez, President and CEO, Canada Health Infoway. Both gentlemen have challenging mandates and there is no shortage of “monday morning quarterbacks” analyzing their every decision and parsing their every word.
Alan Gregg, noted pollster and social commentator, moderated the session. For someone who professed to know very little about eHealth, he demonstrated an amazing grasp of the issues. Citing his own research, Mr. Greg offered the following observations:
- Physicians view themselves as independent operators.
- Physicians don’t want bureaucrats dictating what they do.
- Left to their own devices physicians will do nothing to promote EMR/EHR.
- Not clear what eHealth offers a politician. Why should they support it?
- Not a “build it and they will come” proposition. Need to get politicians, patients and physicians to buy-in first.
- eHealth is very much a communication and engagement issue.
Before taking questions from the audience, Mr. Gregg interviewed Dr. Blumenthal and Mr. Alvarez. Some highlights of the conversation with Dr. Blumenthal included:
- “Meaningful use” is a powerful concept with which to measure progress. Dr. Blumenthal stated that “meaningful use” was one way to ensure that technology was making a difference. He further elaborated that “meaningful use” starts with where we want to be with healthcare, not with what we want to do with technology.
- Biggest challenge will be creating interoperability. Felt that adoption will happen in any event, if only because new physicians will bring it to the practice of medicine.
- US is employing a “carrot and stick” approach using financial incentives / penalties through Medicare / Medicaid funding.
- When asked about the business case for eHealth, Dr. Blumenthal cited his personal experience as a primary care physician. He stated that he was initially a reluctant EMR user but became a convert through a series of personal experiences. He shared one of these stories in which an alert generated by the EMR gave him the information he needed to cancel a diagnostic imaging test that he was about to order. Dr. Blumenthal used this personal anecdote to demonstrate that hard cost savings that are possible through immediate access to all relevant patient information.
- Thinks that the Scandinavian countries are perhaps the most advanced with regard to eHealth use and adoption. He noted, however, that these countries are considerably smaller than the US or even Canada and are still struggling with a framework for information exchange.
Highlights of the conversation with Mr. Alvarez included:
- Accomplishments to date include:
- Have put standards in place
- Have defined an eHealth architecture that is used by all jurisdiction
- 300 projects currently underway, most of which are in the implementation stage
- Every province is at a different stage, with some provinces, like Alberta, much further along the path to having a comprehensive EHR in place.
- Have made significant progress in diagnostic imaging and telehealth
- While Infoway could have started with EMRs in physician offices, they did not feel that it was the right approach at the time. Now that other core pieces of the EHR framework are in place, Infoway will be committing a significant portion of the recently received $500M federal government investment in to EMRs and interoperability.
- Mused about the challenges of Canadian federalism and noted that with regard to eHealth, the jurisdictions are more collaborative than they are with respect other aspects of health.
- When asked about the business case for eHealth, Mr. Alvarez indicated that Infoway has systematically examined the benefits and identified on the order of $6B in savings. Recent studies of the benefits of diagnostic imaging and drug information systems have shown savings on the order of $1B each.
- With respect to “meaningful use”, Mr. Alvarez stated that Canada has been “muddling along” with respect to adoption metrics and will be borrowing some ideas from the US in this area.
- Mr. Alvarez challenged the belief that it is “taking so long” to implement eHealth. He noted that the banks took decades to go from computerizing their ledgers to the on-line banking systems that we know today. Mr. Alvarez asserts that eHealth implementation is a 10 to 15 year journey and that Canada is making good progress.
This plenary session was probably one of my favorite events at the conference. I continue to be amazed by Dr. Blumenthal’s leadership and was pleased to see Mr. Alvarez acknowledge that Canada could learn some lessons from the US approach.