7 Questions... With Dr. Robert Kolodner

1. What major goals do you hope to achieve during your tenure, and which is the number one issue on your list?My goal during my tenure is to help move the health IT agenda from one phase to another. When David Brailer was here, he and his staff were setting up the Office of the National Coordinator for Health Information Technology and put a lot of effort into establishing a solid foundation. Now we’re shifting to the next phase, where we need to execute and begin delivering on the plans that are underway. For example, when the American Health Information Community recommended in October 2006 its first set of EHR interoperability standards to the Secretary of the Department of Health and Human Services, it was the end of the initial phase of development; we went from proposing ideas to identifying and creating the standards that are needed to support interoperability. We’ll also move forward with the EHR certification process and identify what we call “prototype use cases”—hypothetical ways in which EHRs would be used in various healthcare scenarios—and then establish the core set of use cases, based on which we will develop the certification standards for these products. As we continue to grow those standards over time, developers will move forward with products that incorporate those standards. We will also continue to make progress toward the Nationwide Health Information Network; we will complete the prototypes and demonstration projects and draw from those to create the next phase of development.

2. What are the biggest challenges facing the HIT Industry?

I think that HIT companies have been making important advances, but since until recently not enough attention was paid to healthcare information technology, patients and providers have not received the full economic benefit of the health IT that is already in place. That’s why we’ve been moving forward with the agenda to create EHR interoperability standards, with the ultimate goal of establishing a nationwide network.

3. What role will the tech industry play in your efforts as National Coordinator?It will play a very active role. In order for us to succeed with our national health IT agenda, we are absolutely dependent on participation from all parts of the healthcare sector. The health IT companies need to be at the table, helping us identify and create the standards, participating in aggressive and achievable plans by which those standards can be incorporated into electronic health records, personal health records, and other products, and delivering them into production. The next few years are going to be a very interesting environment and create a growing opportunity for health IT vendors.

4. How has the CCHIT certification process for EHRs played out with the industry?From what I can tell, it’s played out very nicely. We started with standards and certification for ambulatory care assistance, which is a subset of all of the systems. We called for two rounds of certification and now have more than 35 products that have passed certification based on the current criteria. Then, starting sometime in 2007, we’ll go into the next round, which will be expanding to inpatient EHRs and upgrading to version II of the criteria for ambulatory EHRs. In 2008, we’ll move toward a network of providers (network services) and criteria for that as well.

5. What tangible outcomes in HIT can practicing physicians expect to see in the next couple of years, and what can they do to help promote greater health IT adoption and implementation?Providers who are already using EHR systems can help to communicate to their colleagues the benefits that they’ve seen and the practical lessons learned in terms of what it takes to successfully implement the systems. Currently, there are a number of useful products that enable providers to do several things, including electronically prescribe and exchange some laboratory information. That will become more and more widespread as we move forward with implementing the standards for interoperability. Providers that have tools that support quality measures will be able to get feedback and see how the quality of care they provide is improving.

6. Is the hype surrounding HIT detrimental at this point because of the high expectations it creates?

I think that the interest in health IT is well worth it. We have non-healthcare, non-IT industries participating in order to create incentives for adoption, because they understand the important impact that adoption of this technology will have on their bottom lines. The traditional statistic that people give is that General Motors pays more for health insurance annually than it does for the steel it uses to make its cars. The cost of healthcare is interfering with the competitiveness of American companies. We need to do something to improve the quality and decrease the cost of healthcare in this nation.

7. What needs to happen in order for a nationally interoperable network of EHR systems to be developed?

The activities we’ve been working on are designed to achieve that. We need to set standards that are implemented in a variety of systems (both EHRs and personal health records), and we need to enable secure, confidential exchange of information among those standardized islands of information. As part of this effort, we will have to identify quality standards and further integrate decision-support mechanisms into these systems, so that they enable providers to deliver higher-quality, safer care, which translates into more efficient care. Doing all this will help enable us to address rising healthcare costs in the future. After we get all of the technologies in place and those tools become an integral part of physicians’ practices, there will be a very subtle but important shift in the delivery of care. Finally, I think we will also see increased use of personal health records by patients and the community, and that particular technology will fundamentally transform the relationship between providers and patients in a very positive way.