Health Information Technology with the Obama Administration

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Margaret, it's our one-month anniversary.

Margaret Flinter: It really has gone by quickly and it's been a lot of fun
and hopefully very informative.

Mark Masselli: I find the conversations we are having with health care
innovators having me go back and rethink some of the ways we are
providing care at the health center.

Margaret Flinter: You are right. And on so many di ! erent many levels it
really is about the innovations that are transforming the way we deliver
care. You can just feel the profound e ! ect that these redesigns are
having from reducing wait times to changing the way we think about
treating patients all improving the quality of the care we give and we
receive.

Mark Masselli: I am very excited about this but I am still restless about
the time it takes to find out about these changes. Hopefully, we are
adding to the body of knowledge for providers and consumers about
better ways to care for our community.

Margaret Flinter: Well, we are trying, and we could not do this without
the help of our producer Lucy Nalpathanchil.

Mark Masselli: Thanks Lucy. One of the high points of doing this show is
hearing from listeners from all over the country.

Margaret Flinter: After our Centering Pregnancy show a few weeks back,
we heard from architect Robert Olsen in Boston. He said that that
particular show gave him some design ideas. We are happy to hear this
show is inspiring people both in and outside of health care.

We also heard from David Willett from Austin, Texas who says he has
been enjoying our podcast at www.chc1.com . David wrote in after
hearing our discussion with Dr. Mark Murray who helped create Advanced
Access a radical redesign of patient scheduling. David said the timing of

this show was perfect as his community health center has been
implementing the Advanced Access approach across 21 sites. He also
gave us some good ideas for future shows, thanks David.

Margaret Flinter: And an update, we are working on our own
Conversations on Health Care website. It will have audio of past shows,
information on guests, our own blog; Mark is pretty excited about that
one.

Mark Masselli: I am.

Margaret Flinter: And pictures and links to topics we have covered about
health care in this country. In the meantime, please send your comments
to [email protected] .

Mark Masselli: Today, we are honored to speak with Dr. David
Blumenthal, National Coordinator for Health Information Technology. He
will bring up to speed on the exciting innovations in Health IT that have
the potential to improve our nation’s health care system. We will also
take a look at the evolution of Telehealth, a new way to connect a patient
with their provider.

Margaret Flinter: But first, here is a look at health care headlines from
our producer Lucy Nalpathanchil.

Lucy Nalpathanchil: I am Lucy Nalpathanchil with this week’s headline
news. The health care reform debate in the senate is in the hands of
Majority Leader Harry Reid for now. He is working behind the scenes to
merge last week’s senate finance bill with another bill approved this past
summer by the Senate Health, Education and Labor Committee.
Questions remain whether the government-run health insurance plan or
public option will be included in the merger or if senators will o ! er up
amendments on the floor. There are several variations of public options
on the table that include creating a national plan only if other plans
approved by the Congress fail to expand coverage. Another is allowing
states to opt into a government-run plan or create their own. In his
weekly address, President Barack Obama says he doesn’t want Congress
to lose sight of an important goal.

President Barack Obama: For the first time ever, all five committees in
Congress responsible for health reform have passed a version of
legislation. We are closer to reforming the health care system than we
have ever been in history.

Lucy Nalpathanchil: As Congress continues to debate, a new Washington
Post-ABC News Poll shows support among the public has grown for a
government-run health plan. The poll shows 57% support the public
option, this support has risen since mid August when just 52% favored
the plan. The numbers jumped to 76%. If Congress allows states to run a
public option for those who lack a ! ordable private options, the recent
poll also shows 56% favor a mandate requiring all Americans to carry
health insurance. Meanwhile Speaker of the House Nancy Pelosi is
working with her members to merge three committee bills whether
reform is a bipartisan e ! ort remains to be seen. So far, only two
Republicans, Maine Senators, Olympia Snowe and Susan Collins, have
shown they are open to supporting reform legislation. Senator Snowe
was the lone GOP member in the Finance Committee to approve its bill.
Senator Collins has indicated she is open to voting for a final bill as long
as it lowers insurance cost for all Americans. The President says he is
hopeful Congress will look past special interest groups who are paying
for TV Ads and reports as law makers continue their work.

President Barack Obama: Every time we get close to passing reform, the
insurance companies produce these phony studies as a prescription and
say take one of these and call us in a decade, well not this time. The
insurance industry is making this last ditch e ! ort to stop reform even as
cost continue to rise and our health care dollars continue to be poured
into their profits.

Lucy Nalpathanchil: Majority Leader Reid has indicated the full senate will
meet by the end of the month.

(Music)

Lucy Nalpathanchil: This week, we are exploring Health Information
Technology or HIT. The term encompasses a lot. The US Department of
Health & Human Services defines HIT as a comprehensive management of
medical information in a secure manner between health care consumers
and providers. And HIT can help providers reach positive outcomes like
e " ciency of care, a reduction of cost and an expansion of access to
a ! ordable care. One technology that fits this description is Telehealth.
Telehealth is the use of electronic and telecommunications technologies
to support long distance care. Dr. Jay Sanders, President and CEO of
Global Telemedicine Group, a health care consulting firm in Georgia,
helped to find Telehealth more than 30 years ago. He says many have
called him the Father of Telehealth but he gives all the credit to Dr.

Kenneth Bird, a professor of Sanders during his residency at
Massachusetts General Hospital. Dr. Bird envisioned a way to reach his
patients faster and avoid tra " c from busy downtown Boston to his o " ce
near the airport.

Jay Sanders: He said Jay, what do you think of my idea. I am going to put
up a microwave link between the hospital and airport and I am going to
put in some TV cameras and I am going to start examining patients over
TV. What do you think?

Lucy Nalpathanchil: The idea hooked Dr. Sanders and he found himself
helping his professor create a Telehealth program. Later, he took the
Telehealth idea to the correctional system when he was awarded a grant
from the National Science Foundation which wanted him to explore ways
to improve health care access for prison inmates but he found his niche
in Georgia when the Governor at the time asked him to create a statewide
Telehealth program to reach Georgia’s most rural residents.

Jay Sanders: We got a grant to develop the first technology to go into a
patient’s home, to be able to examine them right in their living room; we
called it the electronic house call.

Lucy Nalpathanchil: The technology was an interactive platform created
to exist on a channel made available by the local cable company. Patients
and providers could see each other in real-time using video cameras so
the doctor or nurse could prompt them to use medical devices linked to
the program like an electronic stethoscope. Sanders says the Georgia
program became the model for other states and is what started the
Telehealth Industry. He says since then Telehealth has evolved beyond
just connecting doctors with patients who live in remote areas. One of
the specialties that picked up on Telehealth was radiology. Dr. Timothy
Myers, Chief Medical O " cer for Nighthawk Radiology, a 24X7 o ! site
radiology service says technological improvements like taking X-rays and
scans or film and transferring them to electronic images changed the
specialty.

Dr. Timothy Myers: So Nighthawk had its focus to support radiology
groups in those hours that they could not cover or had di " culty covering.
Those hours were typically the evening hours, the overnight hours and
many times weekend hours with the increase in requirements in medicine
in general to have 24X7 coverage and standard of care levels that were
the same regardless of whether or not it was 2 o’clock in the morning or
2 o’clock in the afternoon.

Lucy Nalpathanchil: Nighthawk radiologists view the X-rays or scans over
the Internet. The images are either sent to a Nighthawk Remote Center
or to the radiologist’s home computer. Dr. Myers says this ability to
connect doctors in emergency rooms with radiologists on call or around
the country helps improve the care patients receive.

Dr. Timothy Myers: While we have maintained the ability to get images
across the Internet as that ability and speed has increased, the number of
images have also increased making the diagnosis that we are getting
back to the physician at the site even better because we are seeing a lot
more and we are seeing it more accurately.

Lucy Nalpathanchil: 15 years ago a slower Internet connection
lengthened the time it took to transmit images; Dr. Myers says it took up
to two hours. Today, he says the time it takes for a Nighthawk
radiologist to receive, review and communicate back to emergency
doctors is 16 minutes on average. He adds future technological
advancements will only further improve an already e " cient specialty. Dr.
Myers recounts a story about a colleague who was in China and was able
to use his iPhone in a practical way.

Dr. Timothy Myers: And so they were able to transmit the images to him
to get him to look at them so that he could consult on the case and get
the patient treated appropriately. That was beyond belief up until just
two years ago really.

Lucy Nalpathanchil: Telehealth isn’t limited to connecting providers with
patients, Telehealth is also the sharing of educational knowledge
remotely. So, to improve access to quality health care at Johns Hopkins
Medicine International in Baltimore Maryland, technology is being used to
connect medical educators and researchers with clinicians worldwide.
Alexander Nason, Director of Telehealth at JHMI says the organization
uses video conferencing units and the Internet to deliver lectures by
Hopkins faculty complete with question and answer sessions.

Alexander Nason: It will be talking head usually with a Powerpoint
included in that and it will be live transmission to a hospital in most
corners of the world at this point. What I am trying to do is build
relationships and build these relationships between providers around the
world and video conferencing is just another tool to use there.

Lucy Nalpathanchil: Nason says not all communities around the world
may have the same technology available in Baltimore. If that’s the case,
they craft the information session using what technology is available in
the local community. Nason says in the future the organization is
looking to further promote itself through mobile phone platforms.

Alexander Nason: Devices like the iPhone are making it available to bring
in both audio and content. I still hesitate about the live video just yet but
I think it's going to happen eventually where an individual could be
synced up through their wireless networks and we able to receive content
in an audio and let’s say a Powerpoint coming to your phone and then
watch it as you are traveling.

Lucy Nalpathanchil: So who pays for Telehealth? Dr. Jay Sanders of
Global Telemedicine Group says federal and private foundation grants
have enabled Telehealth to grow over the years but now insurers like
United Healthcare are taking the technology seriously.

Jay Sanders: With 70 million enrollees in partnership with Cisco said that
they are going to develop nationwide telehealth networks. Number 2,
they signed a contract a few months ago with a company in Boston called
American Well that allows all of their enrollees to use a web cam and to
be able to seen by a physician wherever they are whether they are at
home or at work.

Lucy Nalpathanchil: With this new technology changing how providers
see their patients it’s natural to wonder how developments are tracked
and who has oversight of the newest telehealth applications and growth
of electronic medical records. To learn more about this, Mark and
Margaret spoke with Dr. David Blumenthal, President Obama’s National
Coordinator for Health Information Technology.

Margaret Flinter: Welcome Dr. Blumenthal.

Dr. David Blumenthal: It’s great to be here.

Margaret Flinter: You were appointed by President Obama earlier this
st
year to lead the e ! ort to bring America’s health care system into the 21
century including getting all health care providers onboard with using
electronic medical records. It seems that some of the drive for this has to
come from the patients. Do you feel that public is aware of the benefits
of HIT or is this something that we still need to get the word out on?

Dr. David Blumenthal: Since computers are ever present in the lives of
Americans, I think they are generally sympathetic to the idea that their
doctors should have the benefit of electronic technology to gather and
process their personal health information. Most Americans believe that
their physicians actually have the benefit of computers already and I think
many would be surprised to know that the kinds of technology that they
get take for granted in their banking and in their making of travel
reservations or in their Facebook encounters are not yet used by most
hospitals and physicians to get the best out of their personal health
information.

Mark Masselli: That’s a very good point. A survey of US Hospitals use of
electronic health records published this spring in the New England
Journal of Medicine concluded the very low levels of adoption of
electronic health records in US Hospitals suggest that policymakers face
substantial obstacles to the achievement of health information
technology. Tell us about these obstacles.

Dr. David Blumenthal: The first obstacle is cost. These are expensive
systems especially for small and medium size hospitals and for hospitals
that are stressed financially. And they are also very di " cult investments
for small physician practices and solo practitioners and for those
particularly like primary care physicians who don’t make much money in
their regular practice. The second issue is kind of a combination of
logistics and technology. It’s complicated to set up so many systems just
like most people need some technical support in getting their own
computers set up at home and keeping them running. You need those in
hospitals and in physician o " ces and it's a little scary to be dependent on
these kinds of systems. Every physician’s nightmare is that their waiting
room is full, they are packed up, they are running an hour late and their
computers goes down and what do they do then especially if they are
really using that computer. So, getting people, the individual physicians
and getting hospitals some technical logistical support is really important
as well. I think those are the two major issues that are in the way of a
much wider spread of this technology.

Margaret Flinter: Dr. Blumenthal, it sounds like you and your o " ce are
right in touch with the concerns of providers. One of the exciting
innovations that we have been hearing about is that the government is
funding the Department of Regional IT Extension Centers around the
country sort of like the agricultural extension centers that we are quite
familiar with and their charge is specifically to help those local

communities and practices get up and running with electronic health
records. Can you tell us about your expectations for that program?

Dr. David Blumenthal: Well you are exactly right. We announced in
August that we were going to be making almost $700 million available to
fund at least 70 of these regional extension centers around the country.
They were modeled on the agricultural extension service which is 70 plus
year old program that helps farmers stay in touch with the latest
information about agriculture and the science of farming. And we think
that that model which by the way was created by the Congress that that
model makes a lot of sense in medicine. We are reviewing applications
for them as we speak. We hope to have them up and running early even
in the new year and we want to give them a year or so to work with
physicians and hospitals locally in preparation for the availability of
Medicare and Medicaid fund that will support the adoption and
meaningful use of electronic health records.

Mark Masselli: This is Conversations in Health Care, we are speaking with
Dr. David Blumenthal President Obama’s National Coordinator for Health
Information Technology. President Obama has said that he wants the
nation’s health IT infrastructure to be connected and not isolated. In lay
terms, this will allow one medical practice to communicate with another.
How is your o " ce working to make sure this happens?

Dr. David Blumenthal: This is so important. I am a primary care
physician, I was a practice for 30 years before I joined this o " ce and one
of the things that I found so valuable about the electronic record I used
was that it enabled me to know what all the specialists that I was sending
my patients to were doing with and for my patients so that I wasn’t in the
dark the way I used to be and I can answer their questions and make my
plans accordingly. The way we are thinking about this has multiple
approaches. First of all, we are and have been creating a model program
for a nationwide health information exchange capability and basically it's
analogous to the national highway system or the national railway system
where you create a plan for linking all parts of the country together for
those who want to travel or communicate using that system. So, that’s
one thing we are doing. And you don’t actually have to create the system
itself because the Internet exists and it creates that kind of system
already but what we are trying to do is make sure that it’s safe and
secure and adapted to medical information. That’s one point. And the
other thing we have done is we have put almost $560 million on the table
for state governments to plan the exchange of information within their
jurisdictions.

Margaret Flinter: Let me turn Dr. Blumenthal for a moment to health care
reform and the goal of reducing cost or at least bending that cost
escalation curve. When you think about the issues care coordination,
duplicate testing, managing chronic disease what’s that relationship to
healthcare information technology that’s going to play a role in reducing
cost there?

Dr. David Blumenthal: The absolute core to better and more e " cient care
is information. The analogy I like to use is that information is the life
blood of medical practice and Information Technology is its circulatory
system. If physicians and other health professionals depend almost
completely on the quality of information they have in order to pick the
right treatments at the right time for their patients, you can’t be e " cient
unless you have the right information and you can’t deliver high quality
care unless you have the right information whether that information is
from diagnostic tests or discharge summaries or the latest kind of
patterns of care that another physician or patterns of symptoms that
another physician has observed. That’s really what makes care e " cient
and high quality. So we want to make sure that everyone knows
everything that they can about a patient when they are seeing that
patient.

Margaret Flinter: The national debate certainly has focused some on
training, the healthcare provider workforce to deliver care but it sounds
like we are also going to be looking for people who are really trained in
health IT to support providers as we build this IT infrastructure. Is there
a plan for this? Is this a growing field where we are going to need to train
more people specifically to work in Health IT?

Dr. David Blumenthal: Yes. Congress actually directed my o " ce to
develop a program to support training of health information technology
workforce. We are working on that program as we speak. We think there
is a shortage of about 40,000 to 50,000 health information technology
workers nationally right now and we think overtime the market will
respond and produce more such people but in the short term to get that
training process up and running that the Federal Government needs to
provide a little pump priming. So we are working on that right now.

Mark Masselli: Dr. Blumenthal, Conversations on Health Care focuses on
innovations in healthcare delivery. From your perspective, what
innovation or person in healthcare technology excites you and that our
listeners should keep an eye on?

Dr. David Blumenthal: When you read in the newspapers about the
greater ability that we have to use handheld devices for example, to
communicate with one another, the same opportunities exist potentially
to link patients with their healthcare providers. And just as an example,
the idea that one could use some of the mobile handheld devices that
people now use to get information about flight status of their airlines or
shopping opportunities, those could also be used to keep people
informed about their health and to remind them of the tests and
treatments that they need to get. So there are those kinds of
technologically empowered ways of communicating with people and
involving them in managing their own health, I think very terribly
exciting.

Mark Masselli: We have been speaking with Dr. David Blumenthal,
President Obama’s National Coordinator of Health Information
Technology. Dr. Blumenthal, thanks for speaking with us today.

Dr. David Blumenthal: You are very welcome.

(Music)

Mark Masselli: Each week Conversations on Health Care highlights a
bright idea about how to make wellness a part of communities in
everyday lives.

Margaret Flinter: This week, if you want to quit smoking, there is an app
for that, Lucy.

Lucy Nalpathanchil: Quitting smoking can be di " cult, there is no
question about it. The Federal Centers for Disease Control and
Prevention say millions of Americans try to quit, but relapses are common
because of withdrawal symptoms like irritability, increased appetite and
anxiety. What helps people succeed, support and now that kind of
support is available right on your cell phone. MyQuitLine is free i-Phone
application that links cell phone users to live counselors. It’s help right
at your fingertips, just by downloading the app on to your i-Phone. When
the app is opened, a short message pops up informing the cell phone
owner that free expert advice from counselors at the National Cancer
Institute Quitline is just moments away. Then the i-Phone user can
choose to hit a button that would call the National Quitline or another
button that launches a browser to start a live chat session with the
Quitline counselor. MyQuitLine is di ! erent from other apps because it’s

linked to Quitline telephone counseling, a method used by many states as
one important element to help people quit. What helps individuals
succeed with Quitline counseling according to the CDC, counseling by
telephone eliminates barriers and traditional cessation classes like having
to wait to enroll in a class, MyQuitLine also appeals to people who want
to get advice one on one instead of in a group setting. MyQuitLine was
developed by a joint project of the George Washington School of Public
Health, and the National Tobacco Cessation Collaborative. They were
grant to use new media technologies to get people access to tools based
on proven therapies. Interested in the MyQuitLine app, it's as easy as
downloading the app from your i-Phone or going to iTunes.com.
Increase in the number of people who succeed at quitting can decrease
tobacco use as a leading cause of death and disease in the United States.
Now that’s a bright idea.

Margaret Flinter: This is Conversations on Health Care, I am Margaret
Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Lucy Nalpathanchil: Conversations on Health Care broadcast from the
Campus of Wesleyan University at WESU, streaming live at
www.wesufm.org and brought to you by the Community Health Center.