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COMMENT ON THE FEDERAL HEALTH IT STRATEGIC PLAN April 29, 2011

For today’s post, I would like to point out the opportunity that is available to comment on The Federal Health Information Technology Strategic Plan for 2011-2015. The Office of the National Coordinator for Health Information Technology has extended the public comment period through May 6, 2011.

For anyone concerned about healthcare, this document defines the government’s plan “to transform the healthcare system by improving the flow of information through health IT.” The Plan builds upon the current healthcare IT programs and also “charts new ground for the federal health IT agenda.”

This comment period provides an excellent opportunity for physicians, along with all other interested parties, to add their voices to the decisions regarding the direction that healthcare in the United States will take in the future.

Here is the link to the ONC website to review and comment on the Strategic Plan – Federal Health IT Strategic Plan Open for Public Comment – and I have included the comment that I submitted regarding of the Strategic Plan below.

Dr. Mostashari -

I appreciate the opportunity to comment on The Federal Health Information Technology Strategic Plan. I would like to first state that I am a supporter for the utilization of electronic health records and believe that health information technology can serve an important role in healthcare delivery. There is a major omission in the proposed Strategic Plan, however, that I find to be a significant area of concern.

Throughout the proposed Strategic Plan, there is the complete absence of a major component for any successful healthcare – responsibility. Responsibility is lacking within this Strategic Plan both figuratively and literally, as the word “responsibility” does not even appear within the document.

The absence of responsibility extends throughout the Plan. The government’s proposal includes efforts to “encourage”, “enhance”, “inspire”, and “promote” efforts for the implementation of health information technology, but at no point does the government take ownership or direct responsibility for the results of these efforts.

The establishment of the Nationwide Health Information Network serves as an example. This Network is supposed to serve as “the preferred solution to securely exchange information nationwide to support meaningful use.” While ONC will establish “a governance mechanism through rulemaking” for the Network, “governance rules will be established as a voluntary solution to health information exchange” and “the government will pursue various options to encourage participation in this preferred solution.” So while the government will create the rules for the health information exchange, and encourage participation in it, it abdicates any responsibility for the outcomes associated with the use of this Network as it remains a “voluntary solution.”

This aversion to responsibility is even more clearly evident in regard to the proposed requirements that are to serve as the foundation for stages two and three of the EHR Incentive Programs. The Plan calls for these stages to include incorporation of “more sophisticated uses of health IT, such as clinical decision support, patient registries, reminder systems, and changes to workflow and clinical care redesign.” The current Strategic Plan, however, fails to address or even consider the repercussions that these requirements will have on the participating providers.

Specifically, the Strategic Plan does not contain any assessment or consideration for the legal consequences and liabilities that these government programs will create. These consequences include important and very practical issues, such as the medical malpractice implications that may result from the incorporation of clinical decision support into the EHR system. The handling and management of patient data caused by participation in registries is another source of significant legal questions, such as when the provider’s responsibility for securing the patient’s data ends and the health information exchange’s responsibility begins.

To address this deficiency regarding the legal responsibilities, I would recommend adding an additional “Goal VI” to the current Strategic Plan. This Goal would be to “Address and Clarify the Legal Ramifications of the Adoption and Utilization of Health IT.”

Finally, the most significant omission of “responsibility” in the Federal Health IT Strategic Plan is the lack of any discussion regarding the responsibilities of one of the major participants in U.S. healthcare – the ‘private’ commercial insurance companies.

If the Mission for this Plan is “to improve health and healthcare for all Americans”, then the commercial insurance companies must be an active participant in this program. These companies play a major role in the management and utilization of healthcare resources in this country. If the current Strategic Plan truly represents the national health IT agenda, then the private insurance companies must be integrated into this plan to a degree commensurate with the position that they currently hold in healthcare, including fully defining their role, the degree of their participation, their financial contribution, and their responsibilities.

Once again, I am very thankful for the opportunity to comment on the Federal Health IT Strategic Plan. I hope that my comments are helpful and constructive, and I look forward to the final version.