At The Helm

June 24, 2011
It's been almost five months since Robert Kolodner, M.D., transitioned from interim to permanent head of the Office of the National Coordinator for

It's been almost five months since Robert Kolodner, M.D., transitioned from interim to permanent head of the Office of the National Coordinator for Health Information Technology (ONCHIT) at the Department of Health and Human Services (HHS). Kolodner had been serving in an interim capacity since Sept. 20, 2006.

Tasked with being the principal advisor to the secretary of HHS on HIT initiatives, he is also responsible for developing, maintaining, and directing the strategic plan to guide nationwide adoption of IT to reduce medical errors, improve quality, and produce greater value.

Recently, Kolodner talked with HCI Editor-in-Chief Anthony Guerra about his first months in office and his plans to promote the adoption of healthcare IT in the United States.

When you took the position on an interim basis, had you made it clear you were willing to become permanent?

When I first came, there was no commitment either way on either side. As we proceeded, I enjoyed what I was doing and they were pleased with the job that I was doing. So we were able to just take it to the next step.

We have seen the stories about AHIC going private. What would you want our audience to know about this debate? What might the implications be for them if it should go either way?

The first thing is to clarify that we really aren't talking about AHIC going private; we're talking about AHIC transitioning to a public/private entity that's in the private sector, as opposed to being simply a federal advisory committee in the public sector. That was the intention all along, even when AHIC was first established, it was to be a first step to gain momentum to have the government get things started and help to take actions that would allow market forces to work appropriately. This was done so that we get the kinds of outcomes that we get in other sectors when automation is incorporated into the fabric of the workflow. We want it to become more efficient, to become more effective. In healthcare, that means safer healthcare, better quality healthcare, more convenient healthcare for the individual who's receiving it; actually, to empower individuals in communities to meet their needs more effectively.

Were you surprised at some speaking out against AHIC becoming this public/private entity? Did you expect that?

Not surprised that there was a difference of opinion. We need to do a good job of conveying what it is, why we want that transition and why we think it's the right thing to do. In particular, we simply weren't making the progress that we needed to make in the incorporation of health IT solutions and in the means of individuals to manage their own health. Many people felt that the government had an important role in helping to move that forward, in helping to stimulate standards.

In the first few years, we have been effective at moving things forward and gaining momentum, so there's a lot of successes that we have achieved. On the other hand, we know that we can engage individuals and communities in helping to advance their interests, and giving them the means to do it so that they have the information necessary to make good value choices. They can help to drive that even faster than the government can. So we have succeeded in taking the first step, that is getting the momentum, and now we believe that the best place for this to continue is in fact not in the public sector but in the private sector.

However, an important aspect is that the government will still be very much involved because we are responsible for providing or paying for about 40 percent of the care of this country. So we will be at the table as well, we're not simply handing this over to the private sector.

It sounds like this move to become partially in the private sector is part of the consumer-directed health-care swing in the industry, to inject market forces to tie positive outcomes with positive financial results. Would you say all that ties together?

It is, although I think it goes beyond what is usually encompassed by consumer-directed healthcare, in that the individuals themselves are very much engaged in the choices. It is meeting their interests and, not only is it helping them to get better healthcare, but it's helping to transform the whole healthcare sector into a very effective system to meet their needs and the community needs. By moving from an intervention based system where we react when people have a chronic condition, we'll be able to actually prevent many of the consequences of those conditions, and we'll actually be able to predict who is at risk and take actions at that time and prevent them from ever having the condition.

What that really means, when you put that together, is that we're not just focused on the healthcare, but we're really helping individuals to manage their health, and we're helping communities to be healthier.

A lot of providers are looking at the trend of consumer-directed healthcare and they're a little nervous about the change that's taking shape. To a large degree, some of them feel that the burden is being shifted for collections and managing the financial aspect of things from the insurers to the providers. With high-deductible plans, providers are going to have much more responsibility for taking payment and doing it accurately. What would you say to providers that fear this new world and how they're going to manage in it?

As we provide the automation in the clinical realm, and the interoperable standardized self-information moves to benefit the individual, it will also make it easier to take care of the payment side because the fractured information will be able to flow back and forth between the provider and the payer. One of the novel scenarios that people are thinking of is that patients would come in, they would indicate their identity with a card and, based on the clinical information that the provider gets from those health records, payment may flow much more quickly to them with these electronic transfers, rather than there being an increased burden on them to handle the billing and payments. The insurance card almost becomes like a credit card and the payments flow back almost instantaneously from the payers.

If you're a CIO in healthcare and you're making a five-year strategic plan, how do you know what to go forward with, what to go out and do an RFP and purchase, if there are things floating around that may change the whole equation of cost for you. For example, if some legislation goes through or gets approved, you may be reimbursed or somehow benefit financially for healthcare IT, but if you pay for it today, then you don't get to take advantage of that down the road. How do you stay in tune with everything that's happening, and how do you know whether to move forward or to stay back?

In order for an institution to deliver high-quality care, they have to have electronic health records used pervasively though their institution. We are moving to reimbursement based on performance, both as a government and as a nation, and we are moving towards making the performance information of this quality readily available to beneficiaries and consumers of healthcare. While an institution may choose to wait because they think they might get reimbursed for the IT, another argument would be that they're going to have a competitive advantage by being able to improve their quality and document that improved quality by adopting health IT sooner rather than later. I think that that is going to become a much more powerful driving force as we move into the near future.

Do you feel that the financial incentives in the pay-for-performance realm are strong enough now to make the investment in health IT a no-brainer?

I think the trend is there. The time that it will take for them to incorporate the health IT into the workflow, and be able to demonstrate the quality improvements, is a sufficient amount of time, but they need to get started now so that they will be in the front end of the reimbursement.

What do you want our readers to know about what you're going to be doing over the next few years, and how should they act accordingly in their strategic plans?

I think there's no question that it will be a requirement in business to have interoperable health information technology used pervasively through the healthcare delivery systems within a few years. There is a competitive advantage to being at the front of that; they will be able to document better quality care. Most of us went into healthcare because we wanted to help individuals and help the community. The use of technology provides the tools by which we could achieve that better than anything else. Health IT by itself is not enough, but it is an absolutely necessary requirement to deliver better quality and care to the people that we care for.

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