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Health Affairs: What I Would Have Cited

Posted Mar 26 2011 10:03am
I recently had the great joy of writing a piece for the Health Affairs Blog entitled " Health Information Technology, the Work is Only Beginning ."

My posting was accompanied by a great piece by Carol Diamond entitled " The Road Ahead for the New HIT Coordinator. "

My posting was a follow-on to a 2009 article entitled " Health Information Technology: One Step at a Time ." This piece too, was in an issue with a wonderful article by Carol Diamond and Clay Shirky entitled " Health Information Technology: A Few Years Of Magical Thinking ?"

The posting was released on March 25. Imperfect and perhaps more controversial than I had intended, I tried to place ONC's work in an historical context. I was limited to 2000 words. Much of what I wanted to say had to be cut clear to allow for a clearer argument. Christopher Fleming, Health Affair's Social Media Manager and his team were invaluable.

I enclose the full list of citations used in longer and earlier drafts of the piece.

Blumenthal and Leadership
I placed Blumenthal in the context of the leadership types described by Garry Wills in his wonderful book “Certain Trumpets.” I also had citations from speakers at a remarkable workshop David Blumenthal held for ONC staff in the first two months of his tenure there. Watching Dr. Blumenthal and his colleague John Glaser in action was insightful. Before they began their work in earnest, they conducted a critical evaluation both of the issues before them and, more subtly, of the capabilities of the ONC staff.

  1. G. Wills, Certain Trumpets : The Call of Leaders (New York: Simon & Schuster, 1994).
  2. F. Ostroff, "Change Management in Government," Harv Bus Rev 84, no. 5 (2006).
  3. B.N. Tabrizi, Rapid Transformation : A 90-Day Plan for Fast and Effective Change (Boston: Harvard Business School Press, 2007).

Historical Context
I wanted to say a lot more about parallels with Clinton’s health care reform agenda and other related events. Most of this didn’t make the word cut.
  1. H. Johnson and D.S. Broder, The System : The American Way of Politics at the Breaking Point (Boston: Little, Brown, 1997).
  2. P. Starr, "Smart Technology, Stunted Policy: Developing Health Information Networks," Health Aff (Millwood) 16, no. 3 (1997).
  3. Markle Foundation, Lessons from Katrina Health, (New York: Markle Foundation, June 13, 2006).
  4. R.H. Miller and B.S. Miller, "The Santa Barbara County Care Data Exchange: What Happened?," Health Aff (Millwood) 26, no. 5 (2007)
Technology Context
ONC built on what came before. I listed some citations on important but at times overlooked seminal documents. The original Thompson/Brailer article is still a good read. Other works - notably the Commission for Systemic Interoperability's urging for a comprehensive prescription drug history - were prescient. We can learn a great deal by revisiting what has already been done and learning from the successes, the failures, and the ideas forgotten.
  1. T.G. Thompson and D.J. Brailer, The Decade of Health Information Technology: Delivering Consumer-Centric and Information-Rich Health Care Framework for Strategic Action, (Washington, DC: Department of Health and Human Services, July 21 2004).
  2. Commission on Systemic Interoperability, "Ending the Document Game," (2005).
  3. C.M. DesRoches et al., "Electronic Health Records in Ambulatory Care -- a National Survey of Physicians," N Engl J Med (2008).
  4. Agency for Healthcare Research and Quality, Findings from the Evaluation of E-Prescribing Pilot Sites (AHRQ Publication No. 07-0047-Ef), April 2007).
  5. L.L. Diminitropoulos, Privacy and Security Solutions for Interoperable Health Information Exchange: Impact Analysis, (Washington: Office of the National Coordinator for Health IT, December 20, 2007).
  6. L.L. Diminitropoulos, Privacy and Security Solutions for Interoperable Health Information Exchange: Nationwide Summary, (Washington: Office of the National Coordinator for Health IT, July 2007).
  7. A.K. Banger et al., Lessons Learned from AHRQ’s State and Regional Demonstrations in Health Information Technology, (Rockville, MD: Agency for Healthcare Research and Quality, May, 2010).
  8. C. Chen et al., "The Kaiser Permanente Electronic Health Record: Transforming and Streamlining Modalities of Care," Health Aff (Millwood) 28, no. 2 (2009).
  9. J.S. Kahn, V. Aulakh, and A. Bosworth, "What It Takes: Characteristics of the Ideal Personal Health Record," Health Affairs 28, no. 2 (2009).


ONC Publications under Blumenthal’s Tenure
David Blumenthal's team were present everywhere communicating, learning, and refining their message. As several people told me over the past two years, even the prose of regulatory documents was well done. As we'd say in where I came from, ONC knows how to write "real good."
  1. D. Blumenthal, "Launching HITECH," New England Journal of Medicine 362, no. 5 (2010).
  2. D. Blumenthal, The Age of Meaningful Use (HIMSS 2011 Address), February 23 2011).
  3. D. Blumenthal and M. Tavenner, "The "Meaningful Use" Regulation for Electronic Health Records," New England Journal of Medicine 363, no. 6 (2010).
  4. M.B. Buntin, S.H. Jain, and D. Blumenthal, "Health Information Technology: Laying the Infrastructure for National Health Reform," Health Aff (Millwood) 29, no. 6 (2010).
  5. Office of the National Coordinator for Health Information Technology, Health It Strategic Framework: Strategic Goals, Principles, Objectives, and Strategies. Version 41, (Washington, May 10, 2010).
  6. Office of the National Coordinator for Health Information Technology, Program Information Notice: Requirements and Recommendations for the State Health Information Exchange Cooperative Agreement Program (Washington: Department of Health and Human Services, July 6, 2010).
  7. M.B. Buntin et al., "The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results," Health Aff (Millwood) 30, no. 3 (2011).

Innovation, the “Mythical Man Month” and other Inconvenient Realities
In my posting, I tried to focus attention on the "trailing edge" and the "mainstream." Some things take time. I fear that I am viewed as a cynic. I am the opposite. Any differences I have are not with the goal but with the pace and method. And these differences are very small.

Some initiatives - especially MU Phase 2 and 3 and State HIE - cannot be rushed are fraught with risk. I think of former Tennessee Governor Phil Bredesen's HIMSS 2007 address where he urged the audience to "build version 1.0 first."

It would be so much easier to forge policy if our remarkable entrepreneurial spirit was frozen. In essence, you need only visit Havanna to see what happens then. The roads of Cuba are filled with American cars from the 50s and 60s . Time warp? Yes. Progress? No.
  1. F.P. Brooks, The Mythical Man-Month : Essays on Software Engineering (Reading, Mass.: Addison-Wesley Pub. Co., 1995).
  2. J.P. Kotter, "Why Transformation Efforts Fail," Harv Bus Rev, no. March-April (1995).
  3. B. Toan, "Wrangling Prescription Drug Benefits: A Conversation with Express Scripts' Barrett Toan. Interview by Robert F. Atlas," Health Aff (Millwood) Suppl Web Exclusives (2005).
  4. C.M. Christensen, J.H. Grossman, and J. Hwang, The Innovator's Prescription : A Disruptive Solution for Health Care (New York: McGraw-Hill, 2009).
  5. M.E. Frisse, "Health Information Technology: One Step at a Time," Health Affairs (Millwood) 28, no. 2 (2009).
  6. K.D. Mandl and I.S. Kohane, "No Small Change for the Health Information Economy," New England Journal of Medicine 360, no. 13 (2009).
  7. Presidents Council of Advisors on Science and Technology, Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward, (Washington: Executive Office of the President, December 8, 2010).
  8. NHIN Direct May "Throw Wrench" into States' HIE Plans http://www.healthcareitnews.com/news/nhin-direct-may-throw-wrench-states-hie-plans.(accessed March 14 2011).





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