June 15, 2007 • Volume 5 • Number 6

FEDERAL EXECUTIVE FORUM

IMPROVING HEALTH CARE THROUGH TECHNOLOGY

May 31, 2007

Broadcast on WFED 1050 AM Washington, DC and www.FederalNewsRadio.com

Moderator

Jim Flyzik, The Flyzik Group

Panelists

Dr. Karen Bell, Director, Office of Health IT Adoption, Office of the National Coordinator for Health Information Technology, HHS

Theresa Cullen, CIO, Indian Health Service/HHS

Charles Hume, DCIO, Military Health Service

Gail Graham, Director of Health Data & Informatics, VA

Patti Obermaier, Partner, Federal Systems, Unisys Corporation

Jason Kimrey, Intel Corporation

Max Peterson, Vice President of Federal Civilian Sales, Dell

FORUM TRANSCRIPT

JIM FLYZIK, THE FLYZIK GROUP

During today’s show we will discuss critical issues facing government and industry leaders in using information technology to improve health care and health care services. (List of panelists) I’d like to hear from each of the panelists about your scope of responsibility and perhaps progress made in your specific areas in your agencies. Karen, can you share with us your scope of responsibility and the things that you are doing in the health IT area?

DR. KAREN BELL, HHS

The Office of the National Coordinator was founded by an executive order in April of 2004. Our charge is to, as the title suggests, is to coordinate activities related to health information technology both within the federal government and externally. We do that in four different arenas. And I’d like to share with you some of our primary successes in those four areas just to start the ball rolling here and then send the ball on down the line.

The first is in the area of governance. The American Health Information Community was founded in July of 2005 and is chaired by Secretary Leavitt, secretary of HHS. Its primary function is to set priorities for the national health IT agenda to make health information available to everyone electronically that needs it at the time of care and also for public health purposes. In order to achieve that vision, the American Health Information Community is comprised of both public and private high level executives.

That community is informed by a number of work groups that make recommendations as well. So in addition to the priorities we have a number of recommendations coming forward from the work group. And the very exciting piece of this is that these recommendations and priorities are in fact listened to, so among the successes that we’ve achieved in the past year have been 1. the executive order that came out in August of 2006 which essentially required the federal government to adopt standards for interoperability in information sharing as well as improved encouragement to do that in our federal contracting.

In addition to that the American Health Information Committee has made a number of other recommendations that have been followed as well and those are all available on our web site www.hhs.gov/healthit.

The second area that we’ve made a tremendous amount of progress in is the area of technology. And perhaps the biggest step forward there has been the results of the health information technology standards panel that have harmonized a number of standards for health IT to ensure that information can be interoperable. I am going to leave a lot more of the information sharing pieces to my colleagues down the line because there’s a lot to share there, and move on to the third big area and that is privacy and security.

I think we all recognize that that is the major area for sharing health information. We have a contract with the National Governors Association to really look at what states are doing around privacy and security and we also have formed a subgroup or workgroup of the American Health Information Committee to tackle the very big issues around privacy and security, so we are moving forward with that as well.

And the last big area has to do with adoption because no matter what you build, if people don’t use it then it doesn’t bring value. And in the adoption arena there have been a number of successes also. One of the things that we have learned in our contacts with our international colleagues is that without clear definitions of adoptions, it’s very hard to understand whether we are making progress or not.

So a report was released in October which not only clarified the definition for adoption, but set the bar for what our levels are within the physician community right now and we are moving into the hospital community next.

The second big area has to do with dealing with risk for purchase of products so a certification commission was formed and it has now certified up to 80 different health products in the ambulatory sector available for people with disabilities.

JIM FLYZIK, THE FLYZIK GROUP

Thank you Dr. Bell, I appreciate that and we do understand that identity management issue and privacy. We had a prior show where we talked about the privacy act and ID and coordination with federal, state and local. Patty over at Unisys, how is Unisys positioned to support some of these health IT initiatives? Could you give us an idea of what you are doing in that area Patty?

PATTI OBERMAIER, UNISYS

Sure. Unisys plays in three key areas in the health IT arena: VA, Military Health and Health and Human Services. In Health and Human Services is my area of responsibility and expertise. But when you look at the work that we provide and how we support the federal government, it really falls into three areas: infrastructure, systems integration and development, and consulting.

And Dr. Bell mentioned interoperability. That’s where our infrastructure plays. We are building large infrastructures to support the interoperability of these systems. Systems development in creating systems so people can access the information, and be able to use it. And last is our consulting work in which we help the agencies as well as the agencies’ consumers whether it be CDC, or the American health public around consulting and specifically Dr. Bell mentioned adoptability and that is one of the things that we are looking at is how do we help the health industry whether it be hospitals, physicians, nurses, or even American consumers, how do you take information, adopt it (sounds like) and use it?

JIM FLYZIK, THE FLYZIK GROUP

Terrific. Charles Hume the Deputy CIO at Military Health Systems. I imagine you’ve got a lot of challenge in front of you with coordination of the military programs, and commercial programs as well as support. Can you give us an idea of the kinds of things that you are involved with and some progress you are making?

CHARLES HUME, MHS

There are some great major milestones in the Military Health System over the last year. In December we completed the fielding of ALTA which is our ambulatory electronic medical record across all army, navy and air force hospitals and clinics. That’s 65 hospitals world wide and some 400 medical clinics.

In addition to the theater of operations, a version of ALTA is also deployed in Iraq and Afghanistan supporting health care delivery. We’ve got some 88 million individuals now with electronic records in our system; we are processing over 120,000 patient encounters every day in that system. So it’s growing very fast. Also in the last year we’ve built on the information sharing that we’ve been doing with the Veteran’s Administration since 2001. A major milestone in the last year when we successfully fielded a system that will cross check pharmacy and drug allergy interactions between the two departments, so the Veteran’s Administration and the Department of Defense each have electronic medical records where physicians on line, computerized pharmacy order entry, when the physician orders a drug, whether that patient’s received the drug in the Department of the Defense or the Veteran’s Administration, if there’s a counter indication there a flag will pop up with that provider in either the DOD or the VA system.

We’ve successfully tested that and fielded it and are in the process of expanding that across both departments world wide. And then back in April of 2007 ALTA achieved its certification through the commission for the certification of the ambulatory health records that Karen talked about so the next version of ALTA that we are about to put out in the field has been fully certified.

JIM FLYZIK, THE FLYZIK GROUP

Great. Sounds like great progress there on that. Jason Kimrey, tell us a bit about the health information group at Intel and your involvement in health IT issues.

JASON KIMREY, INTEL

Intel is not always the name that you think of when you think of health care but as the leading ingredient supplier to the industry whether it’s desk tops, servers, notebooks, we feel it’s incumbent on us to make sure that people get the advantage of the technology that we are coming out with and really take advantage of the possibilities that’s needed in no greater place than the health care industry.

So we are working very hard within the health care industry to make sure that the latest technology that’s coming out from our partners is used to help in the delivery of care. We are doing that in three key areas. One is in health care IT space; another is in the personal health arena and lastly in the policy and standards and with these efforts combined with our partners here at VA and Military Health as well as at HHS is absolutely critical to ensuring that technology is used effectively to improve the delivery of health care.

JIM FLYZIK, THE FLYZIK GROUP

I think we all know that it’s going to take a combination of policy and hard work from the program folks as well as technology to make progress in this important area. Gail Graham, Director of Health Data and Informatics in the Veteran’s Administration, I’m sure you are in the middle of many, many issues around health IT. Can you give us an overview of what you do and the progress you are making in some of your programs?

GAIL GRAHAM, VA

Certainly. The programs that I oversee are the implementation of our electronic health records. VA has slowly implemented the electronic health record in all sectors, outpatient, inpatient, long term care, and in home health we are doing a lot with keeping veterans in their homes and avoiding long term care placement or other things that would take them away from their families. We are also delving into personalized medicine in conjunction with Secretary Leavitt’s initiatives but looking at research in the use of genomics to improve our decision support that we provide to our physicians in treating our nation’s veterans to ensure that not only do we monitor for the normal decision support things like drug interactions.

We are also doing a great deal with the data on the national level, using it for biosurveillance and working with the Centers for Disease Control and Prevention in their Bioscience (sounds like) project, which is an exciting endeavor. We’ve done a lot with the emergency responders in using our electronic data; in Katrina for example we used our electronic data extensively as veterans relocated to other places and to treat non veterans in a humanitarian setting. Exciting times.

JIM FLYZIK, THE FLYZIK GROUP

It is exciting times. Keep up the good work. Max Peterson over at Dell, give us an idea of your involvement in health IT.

MAX PETERSON, DELL

On a national level, Dell is involved through things like the Technology CEO Council and our own dedicated health care review to help set standards and to help make sure that technology is addressing the needs of the nation’s health care system. In particular with the amount of cost involved. I think it’s about 70% of gross domestic product now and growing. There’s a tremendous opportunity to help improve productivity, drive costs down and keep them in control, and also to improve outcomes. At a local level, I’m responsible for Dell’s federal health care initiative. And we really try to do two things. The first thing is listen to our customers and respond with technology solutions that meet their specific needs. And there’s a lot of work that we are doing with ALTA and the VA and other parts of the federal government. The second thing is to try and share technology futures and help people share best practices. So we try and take some of the experience we’ve got from our health care division and our technology and research and bring it appropriately to the federal market place to address these issues.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. I’m sure the sound bite there that people like hearing is that listen to the customer; make sure you deliver what they want as opposed to technology trying to drive the issues. Theresa Cullen, the CIO in the Indian Health Service, I’m sure you’ve got some unique issues being in that role. Can you share with us some of the things that you have been doing and the progress that you’ve made in the past year.

THERESA CULLEN, HHS

We do have unique issues. I want to preface this by saying that over 25 years ago however we embarked on an endeavor in conjunction with the VA to take the solutions that they had developed in the federal and states and adapt them for use in our communities. What we bring to the table is a long and historical wealth of information working with rural, minority, under served patients in fiscally constrained situations.

And what we’ve been able to show is that despite that we’re still able to effectively deploy health information technology solutions. Despite all those problems that constrain us and constrain many other communities throughout America, we’ve been able to show how the effective use of HIT can be used to not only improve health care delivery but really to ultimately improve health care status and attempt to address health care inequities and disparities and our health IT system we believe has been a major conduit, and a major enabler to ensure that outcome.

JIM FLYZIK, THE FLYZIK GROUP

That’s great. Certainly something that needs to be done. We are going to shift the show over and start talking about opportunities and challenges that we are going to be facing.

JIM FLYZIK, THE FLYZIK GROUP

Welcome back. We are talking health IT and using health technology to improve health care and health services. We’ve got an idea of each of your areas of responsibility. Let’s talk about some of the things you believe or some of the opportunities you see where we can make dramatic improvements by using technology to improve health care. Let’s start with Gail. Gail, what are some of the areas where you see opportunities for marked improvements?

GAIL GRAHAM, VA

Certainly as my DOD colleague indicated we are making great strides in providing services to our returning veterans involved in the global war on terror and making sure that they have seamless transitions from their military service to the Department of Defense. So we are doing some exciting things there, looking at new things that are coming out of that conflict such as the treatment of traumatic brain injury and are really setting up electronic reminders to providers of signs to look for so that we can stay abreast of that. Endeavors that we have been into that have been really exciting over the last year include also the broader expansion of the personalized health record.

Our veterans have access to www.myhealthyvet.org where they can find general health information also can see certain parts of their record, can request prescription refills, request appointments and really drives us towards that patient involvement in their health care which is so important for all of us to keep in mind. And as I spoke about earlier there’s the broadening the use of home help and home help devices that really monitor vital signs of the patient to look for early warning signs so that we can avoid unneeded hospitalizations. So I think expansion of all of those things is really very exciting.

Some of the challenges we share with the private sector, they are not unique to the federal sector, as Dr. Bell indicated, the work in health standards. Many times for example, in the work that we’ve recently done in the Department of Defense, we are just ahead of the standards adoption curve and have to move out in front of that and so it is an exciting thing to do but it is also a challenging thing to do. So we are really working more and more with our private sector partners and realizing that for both VA and the Department of Defense that many of our veterans and active duty members receive care outside of our circumstances as well.

JIM FLYZIK, THE FLYZIK GROUP

It’s important work. It must feel good to know that you are doing work that is essentially about saving lives and a lot of parents of our brave men and women overseas are counting on you. So it’s good to hear the progress bring made there. Charles over at MHS, what are some of the opportunities and perhaps challenges that you face there as you move down the road?

CHARLES HUME, MHS

A major area of emphasis right now is on sharing the data with the Veteran’s Administration as Gail said. The Department of Defense and VA have a strong relationship with the nature of our patients naturally flowing from the Department of Defense for health care to the Veterans Administration as they move out of the service end. With a war going on, that’s even more compelling and so we’ve made a lot of progress in sharing data. Starting back in 2001, with the movement of all our electronic data to the VA as the service members separate, but now what we are seeing is increasingly our patients are being treated back and forth between VA and DOD. And so we are sharing information in real time.

This year the two departments will begin to share, we’ve been sharing mostly ancillary data, pharmacy data, laboratory data, radiology information, and then the next big step is to share the actual provider notes after an encounter and so that when the patient presents at either department the record of care from both departments is immediately available. Like Gail said though, DOD purchases care from the private sector for about half of the care that our patients receive. And so the work that we are doing with VA I’m hopeful will promote a national standard and perhaps establish a national standard on how we can share information among a much broader population.

JIM FLYZIK, THE FLYZIK GROUP

That sharing is a long term, you don’t want somebody who leaves the military and moves over to have to start over again with establishing new records. I think that’s real important and it’s a productivity improvement to have that in place. Theresa, what do you see are some of the bigger opportunities down the road as well as some of the challenges that you need to overcome?

THERESA CULLEN, HHS

I think the opportunities are some of what Gail alluded to when she talked about the patient. I think it’s really important that we remember that. We need to provide patient centric care as well as we need to provide community and population centric care. So IHS has really adopted the model that the four perspectives that health IT can bring to the table, the patient perspective, the provider perspective, the community perspective, and the population perspective, are probably all as important as you try to improve health status. In terms of the individual patient however, what we are trying to learn is what actually activates the patient.

What information can we give a patient through the health IT system, for instance if we show them their data in a graphical display, are they likely to get activated or are they more likely to say you know I really do want to control my diabetes or my hypertension and then use that data to then roll up in a sense aggregate the data that will enable us to assess the health care status of that individual patient within their family and within their community. And then use that data ultimately to really activate the community so that there’s recognition that the health care status of the health of the individual patient is really contingent and dependent to some extent on the health status of a much larger arena.

JIM FLYZIK, THE FLYZIK GROUP

Tremendous. I like that emphasis too, the focus on the patient there as a way of prioritizing programming. Let’s go to Dr. Bell. From your perspective what do you believe at HHS in health IT adoption, what are some of the opportunities and challenges you are confronting today?

DR. KAREN BELL, HHS

Well, I have to agree with my colleagues that what we really have as an opportunity is to create a person centric or person focused health care delivery system. Right now we function in a very fragmented provider focused, payer parsed (??)   health care delivery non system. And in order to truly get to that person focused arena we need to be able to provide information to patients at the time that they need and want it. We have to be able to do that in a secure way, we have to be able to do that in a very usable way. Secondly we also need in order to achieve that, the appropriate policies and business cases.

And so I would suggest that one of the major challenges that we are going to be facing is the fact that our current system has multiple stakeholders in it with no clear business case for any one entity to move forward to that person centric model. The alignment of the business case I think is our biggest challenge to moving forward and I’ll also just comment on the fact that workforce issues are huge as well. We do not have a workforce and we do not have enough folks to train the trainers. So workforce is another big challenge.

JIM FLYZIK, THE FLYZIK GROUP

Yes, that issue has come up on a number of our shows. The lack of depth in a lot of areas.  Hopefully that issue can be addressed at a much larger level across all government. We’ve heard that governance issue come up before and if we have time on today’s show I’d like to talk a bit about how we coordinate with state and local and non-government organizations, which obviously needs to be done for this to work. Let’s hear some private sector views on this. Jason at Intel, give us an idea, what do you think are some of the opportunities and the challenges that need to be overcome to move forward with using IT technology and improved health care?

JASON KIMREY, INTEL

I think that looking at the broader health care industry, there’s a real opportunity to learn. I think too often in this industry we’ve reinvented the wheel and we’ve implemented new solutions just to replace old ones and we’ve not really learned from the good things that have already been done and I think that I hear data interoperability being mentioned here and the work that is being done between military health and VA is really outstanding and it really should be used as a model for the health care industry at large.

The issues that they are facing around data sharing between agencies is really no different than the issues of sharing data between a primary care physician and the specialty physician, the issues around sharing data between a physician in a hospital or even one hospital in one community to another hospital in another community. The difference is that the VA and the military health system is the one doing it today. And I think there’s a lot of key things that we could learn from what they’ve done and really expand that and learn and implement and improve the overall delivery of health care throughout this country.

JIM FLYZIK, THE FLYZIK GROUP

Max at Dell, what do you see as some of the bigger opportunities as well as challenges that need to be overcome?

MAX PETERSON, DELL

I was talking earlier with Charles and when I hear electronic medical record and all the things that we are doing to try and establish that record of health, it brings to mind for me the technology challenges and so I think data explosion. The amount of data, the different types of data, the ability to have a records management system that supports interoperability, security and access to all that information. There’s a huge amount of information that’s growing out there.

I think from a technology perspective, we need to bring to the table ways and means to help customers through virtualization, through data storage technologies and through security technologies to help that vision of an electronic record really be enabled. That’s a huge technology opportunity from our perspective.

And then interoperability. Several people spoke to how the patient wants to receive care. And that’s that they don’t want to go to one place for one provider. People don’t stay in one place and so interoperability and the ability to access those medical records where ever the patient is, at home, on travel, at a specialist or at the primary caregiver is an enormous technology opportunity and a challenge right now also.

JIM FLYZIK, THE FLYZIK GROUP

Yes, I want that. Every time I go to a doctor they hand me those forms and I have to fill out that information again and again and again and again. You know having been a CIO once myself I keep saying why can’t we come up with a system and just move this stuff around electronically. I understand there are privacy concerns that need to be addressed but I think those concerns can be addressed. I’m glad to hear that industry is stepping up to try to make some attempts and make some inroads in that area. Patty over at Unisys. Unisys has done quite a now in the IT area. Maybe you can explain what do you think are some of the bigger opportunities in front of you as well as some of the big challenges that need to be overcome?

PATTI OBERMAIER, UNISYS

Be happy to. At Unisys we see as our key opportunities or the opportunities for health IT all around the capture and the correlation of the data. So we talked about capturing a lot of data for the patient when they are traveling around but then the key thing is also correlating that data. If you are sick, what are your symptoms, what’s happening? One of the key challenges of capturing all of that information for the patients is not to overwhelm them. They are going to have so much information and how do you present it, will it be graphically, whatever the case may be. How do we enable the patient to be empowered in their health care and not overwhelm them with so much information?

In terms of the challenges we see quite frankly I see the incentive for private sector to adopt electronic health records where is the incentive, where are the rebates or tax breaks whatever the case may be. Not necessarily the large hospital organizations but the smaller primary care physicians in the smaller regions. What is going to be the incentive to adopt that information? And then the second is going to be the use of that information. How do we use this information? Is it really driving better health care? It’s going to include quality, it’s going to save costs, and it is going to where we can actually track it to the outcomes of our health. So I think those are the two challenges. Not only the incentive to adopt it but then the usability of the information.

JIM FLYZIK, THE FLYZIK GROUP

Great points. Another issue that comes to mind when we talk about health IT is we have state programs, we’ve got local programs, we’ve got private sector programs, and we’ve got nongovernmental organizations such as the Red Cross and others that are involved in health care issues. How do you go about trying to gather in all those stakeholders and try to coordinate these programs so that things being done at the federal level are consistent with things at a state and local level. Karen, can I ask you to give us an idea about how would you go about getting an understanding about what’s going on with the stakeholders at the state level and the private sector.

DR. KAREN BELL, HHS

Thank you Jim. We actually have several contracts to do exactly that. One of them looks at variation in privacy issues among all the states and tries to harmonize some of the information there. Then the interesting piece about this is as we look around we see a lot of variation but a lot of it also is interpretation. We discovered that many states interpret HIPAA differently, the HIPAA privacy laws. Many interpret the Clinical Laboratory Information Act differently so that they have information flowing differently in one state than another. So we are dealing with a lot of security issues through that contract. And then we have a second contract that is looking at other issues related to health information technology.

Things such as whether or not there is ability to do eprescribing in every state. Such as the problems that occur with individual state licensure of physicians so that they can’t practice across state lines. So we have a mechanism where we are trying to bring all these together and harmonize if you want to use that term for 50 different states in a way that makes it easier for information to flow across state lines.

JIM FLYZIK, THE FLYZIK GROUP

Theresa Cullen over at Indian Health Centers, I know back when I was still in government I had the opportunity to head up the reinvent the government program and one thing we had to take a look at was addressing the various tribal governments who had different governance structures, different rules and so forth. I would imagine there are some interesting challenges there. How do you go about coordinating things at the federal level, not only with state and local but with tribal governments?

THERESA CULLEN, HHS

That’s a great question because as you know the tribal governments have a federal to federal relationship with the federal government. So it’s not that we can impose any regulations on to the tribes, they have to actively participate and agree with it. What we’ve done in terms of data sharing is work to develop model data sharing contracts so that the tribal programs buy their own their data are then able to share with regional health information. And we have some early successes on that to indicate that we have been able to successfully share data at the regional level. In addition, because we are a public health agency we have active state sharing with things that are critical to states.

For instance immunization sharing, we have shared 10s of millions of immunizations with some of the state registries. What Karen said however is critical. As we have 50 states if we have 50 different states with 50 different ideas of how they want to share the data it makes it very difficult for any kind of federated sharing model to develop. So we are working closely with the CDC and other people to ensure that when we write appropriate interfaces for data sharing especially in the public health arena, that we really actually only have to write them once. And then everybody will be able to use them.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. Gail, over at VHA, I know you need to coordinate with DOD and the other ones but do you have to reach out to state and local and private sectors’ needs and requirements? Is that something that you are working on? How do you go about doing that?

GAIL GRAHAM, VA

It certainly is. In addition, also the Indian Health Service. We have many VA employees on regional health information organization activities at state, local, county levels where they are being involved in what is going on in their area to try to fold that into the larger national view. As Dr. Cullen indicated VA has a similar approach that we really want to have one interconnectivity mechanism for everyone we share with, so we continually stay abreast of what’s going on in the different areas around the country and try to keep everyone informed.

We also have a large network of state veterans’ homes that we facilitate their implementing electronic health records as they go down that road. They choose to adopt electronic health records where we provide access to our information as they treat veterans in those state run veterans’ stay at home programs. Also with the biosensor activity that I alluded to earlier, we are doing comparisons of biosurveillance data with state information and state and local health departments. On a variety of levels we are dealing with state and local government.

JIM FLYZIK, THE FLYZIK GROUP

I guess that biosurveillance stuff became a bigger issue with things like anthrax and 9/11 and some of the thinking about the unthinkable and what could happen in those kinds of areas.

GAIL GRAHAM, VA

It was looking at disease outbreaks.

JIM FLYZIK, THE FLYZIK GROUP

Charles at the Military Health System, do you have requirements for outreach to state, local and private sector entities in your day to day operations?

CHARLES HUME, MHS

We sure do. Mostly with private sector. As I said before our beneficiaries get about half of their care through the direct care system in the military. Our military hospitals, but about half of their care is out by private physicians. They are increasingly becoming parts of regional health information organizations all over the country and so our challenge is we want to be able to share data with those RHIOs  but not in a different way with every RHIO so the work that the ?? is doing with the national health information networks in establishing standards there is very critical to us and we are participating on those plans.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. Over at the private sector here, on the same question and there it’s sometimes a little different challenge. I know from working with some private sector companies usually you have your federal team, your state team, your local team. But I think some issues like this that sort of challenge that traditional governance structure even within the private sector where there’s going to be a requirement to make a lot of this stuff work seamlessly, do a lot more coordination. Max, how about at Dell, how do you coordinate things that you are doing on a federal level with things that are going on that perhaps Dell’s doing at the state and local levels?

MAX PETERSON, DELL

Jim that’s a great question. In fact early on I described Dell’s health care unit and my responsibility is being able to leverage that in the federal arena. At that national level, Dell has actually worked with a number of different technology companies to help establish what we call ehealth care architecture. More information is available at www.dellforhealthcare.com but our goal again is to listen to our customer requirements and then put forth the technology architectures that help to drive interoperability.

Everybody recognizes that it’s a heterogeneous computing environment so those architectures have to be able to address the diversity of systems that the federal, state and local and private health care providers have. They also have to address the security aspects that are just vital because for the public and for federal employees utilizing our health care systems to be competent in doing some of the things that we are talking about they’ve got to be confident in the security of their systems, the integrity of the data and their ability to participate. So I think IT industry can help develop architectures that support the customer’s requirements for these various initiatives that we have talked about.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. I’m also going to want to hear from Jason and Patty on the same subject.

Break

JIM FLYZIK, THE FLYZIK GROUP

We were talking about coordination of federal programs with state and local entities and non government organizations. I posed out there the issue that many times companies that work with federal government are often structured with federal teams, state teams, local teams, yet an issue such as this breaks down that traditional governance structure and requires a lot more coordination. I was curious about how the private sector companies we have here today are dealing with that. Jason, how about over at Intel? How do you coordinate the things that you are doing at the federal with all of these programs around health IT that are going on at the state and local levels?

JASON KIMREY, INTEL

Intel’s digital health group certainly represents the entire health care industry and whether it is activities at the federal level, state level, local level or commercial, everything is very well integrated. But we have certainly found that whether it’s in the commercial sector in the public or in the local sector everyone is really watching what is happening at the federal level and watching where the ball is going and implementing accordingly. So what we still continue to focus on is this concept of public/private partnerships. A couple of examples is military health we’ve entered into collaborative research agreements.

To make sure that the new technology that is coming meets the business processes and the challenges that are actually being faced in the industry. Intel also is playing a key role on a committee that Dr. Bell is involved with our chairman Craig Barrett serving a key role on that. Again this whole concept around the public/private partnerships and we’ve found the more formalized you can make those relationships the better.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. Patty over at Unisys how do you do some of this coordination with all these various stakeholders that have major roles or certainly roles in these programs?

PATTI OBERMAIER, UNISYS

I’d say structurally we do separate things like you had mentioned Jim. We do have a state and local group we have a federal group and then we have a commercial group which serves our pharmaceutical and our insurance companies. But there is a Unisys health care working group where we pull everyone together because while we operate separately we all have the same mission and it’s critical, especially with some of the issues that we are all facing, to come together.

Also we do have our client advisor groups which pull in our key customers from all these different areas together to come and talk about their missions, where they are going, what’s happening and how it’s going to affect the different partners. So we operate collaboratively even though structurally we are separated.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. We are moving into the final segment of our show and I’d like to do what we always like to do, is look out to the future of what we might expect. A vision of change and what our world will be like maybe in the future around health IT. There’s a lot of energy around this subject and presidential elections are getting into full swing. Certainly health care is a major priority and I imagine we will hear it debated heavily throughout these presidential elections.

There’s a lot of energy around electronic health records, we hear talk about some type of health card or health ID. All these things circulating around and I’m curious, I’d like to in the last few minutes that we have left here to hear from each one of our panelists your vision of where you see all this going, what it might look like in a few years out, what our health care system might look like. We’ll start with Theresa Cullen at Indian Health Service. Theresa give us your version of where you think this is all going and some ideas of what we might expect in the future.

THERESA CULLEN, HHS

I love the opportunity to envision where I think we are going to be with health IT in the future, but I think back to my teenage years when I used to watch Star Trek and McCoy always had that little thing that told him everything that was wrong and so my vision is that at some point I’ll have a little machine like that. But in the meantime what I think for health IT as a country, as an agency, as a federal partner, the goal is really for us to figure out how to have an interoperable system that is patient and population centric, that relies on the integration of knowledge and data so that we truly have true knowledge management within the health IT system which we really don’t have right now if you look at any of the studies.

And that with the ultimate goal for us of trying to look at health disparities and how to minimize that. And I really believe that health IT is an enabler and I think there is early data that shows that. So it’s a visioning exercise but it’s really based on reality.

JIM FLYZIK, THE FLYZIK GROUP

Yes, terrific. Max Peterson, how do you see the future? Where do you see all this going? As companies do, you sit behind the door, you do some strategies, and you think about your 5 year plans and so forth. What do you think this all means? What will we see in the future in using technology to improve health care?

MAX PETERSON, DELL

Well Jim I love Theresa’s challenge. So how does Dell make that little telecommunicator thing that McCoy used? What a great challenge. Hopefully that’s what we are all working to. In the short run I think what we are driving to is a functional interoperable health information system.

One of the reasons why America’s health care system doesn’t rank as high in the world as we’d like it, I think I saw something that said it was 37^th in the world, is because of that dis-aggregation of information and because of the extent to which the system has been a paper, manual, very individual and personal process with your providers. I think the opportunity there is to use health care, maybe build these telecommunicator devices, but use the technology available today to get gains in productivity, gains in efficiency and quality and I think the successful solutions are going to be the ones that are simple, affordable, interoperable and secure.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. You know this, every time we do a show we come up with ideas for new things to do. I’m hearing again what we’ve heard in many other shows, this issue of the need for better information sharing being a top priority. And we’ve heard it from the show we did on intelligence sharing. We’ve heard it on a variety of shows. Everyone’s talking about better information sharing. We have to realize the act of harmonization of the driver’s license.

It seems to me we ought to have a show sometime that talks about all these various information sharing initiatives going on across government, how they might begin to form some standards to work together so that we are not all coming up with separate programs for information sharing. Thanks for those thoughts Max. Gail, from your perspective over at Veterans’ Health Administration, what is your vision for the future? Where is this all going?

GAIL GRAHAM, VA

Certainly for our department we hope that the label we’ve received of the best care anywhere continues into the future and is further enhanced by the development of health IT but also our development of people. About 2/3’s of medical trainees in the country go through the doors of VA facilities and we certainly want to leverage the spark we ignite with those trainees and the use of health IT in delivering safe effective care and so really just looking to that in the future and using it as a way to draw the best and the brightest into this field.

But also looking at really using the data more wisely, finding different ways to not only present it to clinicians so that they are not overloaded and in health IT there’s a term of alert overload. We alert them about so many things that they become desensitized. Certainly refining that so that those alerts are personalized to the patient but also provide rapid relevant information to the provider at the time of care.

Also in the area of identification of the patients it’s one of the areas that the Department of Defense and VA for example have had to move forward with, absent health ID or universal health identifier and I think we’ve been successful, we’ve proven that that’s not something that should absolutely stop you from this data sharing by using other methods, algorithmic methods to identify patients. So I see further enhancements in all of those areas as the future for us.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. Full speed forward. Maybe Jason we should be asking you that question about Star Trek and a smart chip that I can swallow and it runs through my body and tells me everything that needs to be taken care of? Tell us your vision for the future.

JASON KIMREY, INTEL

Well to be honest with you those are the types of things that we are working on. A lot of people don’t realize that the transistors that we are manufacturing today are actually half the size of the influenza virus so when you start thinking about concepts like molecular diagnosis, and lab ownership, the thing that you are describing actually isn’t that far off.

JIM FLYZIK, THE FLYZIK GROUP

Smart pills.

JASON KIMREY, INTEL

It’s possible. I think one of the things that Intel has found and this is through 10 plus years of research in the health care space is we can’t simply just force that technology and expect it to solve problems whether it’s in the health care industry or others. But specifically in health care we’ve really had to relook at the way that we introduce technology. We really try to understand what are the problems that people are facing in the health care industry today and how can technology solve them 

So we are really relooking at all of the products that we introduce and trying to make sure that the things we are coming out with actually solve the problem. A great example that’s just been released this year and people will start to see it really flourish over the next few years is this concept around tower PCs that are really designed for the health care industry. Intel introduced a new product category this year called the mobile health assistant.

It takes the standard cabinet PC that people have seen but redesigned it specifically for the health care industry. So in this case it is ruggedized, it has a handle, it’s washable, it has an integrated camera, integrated bar code scanner, things of that nature that are specific to the health care industry and we think will improve the business process and the clinical flow that is so important in this industry.

JIM FLYZIK, THE FLYZIK GROUP

I know a lot of the doctors are real proud when they implement some of this stuff. When I go to the doctor there are signs in there, we have gone completely wireless and paperless and prescriptions now are electronically sent to the pharmacy. It’s starting to happen and these things are moving along and I think some of those issues about doctors’ acceptance are becoming non-issues and it looks to me in my small samplings from the doctors I’ve been at that they love the new technology because it reduces the amount of time that they have to spend with paperwork.

JASON KIMREY, INTEL

The key, just to be quick, is we’ve got to make their job easier; we can’t make it harder so that’s our goal in technology to do that.

JIM FLYZIK, THE FLYZIK GROUP

Charles how about over at the Military Health System, what’s your vision for the future here? Looking down the road a little bit, what do you see in terms of improvements?

CHARLES HUME, MHS

Well the obvious holy grail that several of us have talked about is the universally accessible patient centric electronic record that every provider can get their hands on to facilitate the best care for their patient. But the other piece of this is that it empowers the patient too. The patient, once we are able to capture all this information electronically and share across all the health care enterprise, the patient then has the freedom to move to the providers that they want to go to. They are not encumbered by the lack of information that’s available to be shared. And further more they can get the care asynchronously with their doctor. They are able to share that information more freely we can facilitate things like home health care where the patient is able to access the health care system directly from home through the health information system so a completely different dynamic and model for health care delivery is the future with information technology.

JIM FLYZIK, THE FLYZIK GROUP

Terrific. I look forward to the ease of use and you don’t need to drive in the car every time you need a piece of information or a prescription. Patty, what do you see as your vision for down the road here? Where is this all going?

PATTI OBERMAIER, UNISYS

Our vision is similar to Charles’ it’s all around patient empowerment, having the information and being taken where ever you want to go. Having a choice to get service here in the United States or anywhere in the world. I heard a term the other day called medical tourism, I had never heard that before, people go anywhere around the world and decide what they want.

Personally I would just love to be able to stop having to fill out the same health records for my kids’ camps and schools so to have one system where I press a button and send it, that would be great. But for us it’s all and having access to the information and deciding what we want to do with it. And who do we want to access that.

JIM FLYZIK, THE FLYZIK GROUP

Yes, I agree and I can really relate to that filling out once. Do once, use many. Dr. Bell, what is your last vision from a panelist – you give us the last word to give us a vision for the future here, where you see it all this going.  

DR. KAREN BELL, HHS

Well it’s difficult to add on to what’s already been said, but I’ll couch it in these terms: I think what we are talking about is a virtual health care system where the ability to get information and care for oneself as well as get care from the most appropriate and well educated and experienced clinicians is available where ever you go. Now that doesn’t mean that you are going to have an appendectomy on the kitchen table, but most of what we do in medicine care can come to the patient. So this virtual health care system is the first way I would couch that. The second is this concept of engaged (empowered) patients. As we learn more about ourselves as individuals people tend to responsibility for our own care. To do more preventive care and in essence take care of ourselves in a way that in the old days our mothers used to take care of us, and now we go to physicians for it. So that ability to really do much more self management is the second big piece. And then lastly as we move to this virtual system we are going to eliminate a lot administrative costs.

There are a number of published reports out there that say that 25% of our almost trillion dollar health care system is administrative, and as we move more and more to this electronic health care arena we will be eliminating many, many of those costs which will then allow us to truly have a system that’s affordable for everyone.

JIM FLYZIK, THE FLYZIK GROUP

I think you are right, I think if we could focus doctors on doing doctors’ work and not have to worry about the administrative side that would make a big difference.

I’d like, before I thank our panelists, to make a few concluding remarks. I’ve been jotting down notes as we’ve been talking. A couple of things have come out. And again it’s very interesting to me to watch our panels on the various subjects how common issues come out. We had this issue of governance come up a number of times on coordination across the various groups, which we did for example with emergency preparedness when you are talking about being prepared for a pandemic flu to keep the health analogy in place here. It requires a governance structure with clearly defined roles and concepts of operations and who does what when.

The other thing we heard again today is this person centric or customer centric? It is not going to work for the government agencies until they figure out how this is done and what is expected of government by the American people to achieve their roles. We heard that theme of workforce again, the lack of depth, the need for qualified people, the need to get good and encourage young people coming out of college with advanced degrees in this area to look at public service as a career and work on this issue.

Because what this issue is all about is improving lives of the American people so it’s a very noble profession to be involved in. And then also we heard a little bit about this virtual health care and engaged patients where patients will have at their fingertips a lot more information and a lot more decision making that they can make right from their home computers by accessing a lot more information. And then finally the issue that we all are concerned about is this idea of the electronic health record and what might that mean and the privacy implications there and I know I’ve been in some discussions about this.

If you go back to prior presidential elections where the idea of a national health card is debated but for various reasons did not move forward, but when we talk about what kind of health records the privacy issue quickly comes up, and the privacy issue obviously needs to be dealt with. But on the other hand I think if you asked me and if you ask most American people, where are your health records today? I doubt many people have any clue where their health records are today. Over the years they probably are many, many places and they have no chance of ever finding them.

So I tend to take the attitude that if you have electronic health records and put them in the hands again, customer centric, focused on the actual patient, allow the patient to control those records about themselves, then we are taking a step forward, we will have to improve a lot of things, including privacy.