The Thursday, March 13 Federal Register (74 Fed Reg 10743) contained a notice for submitting nominees to the new committees created under ARRA-HITECH (stimulus bill) for developing health information technology standards and policy. The two commitees will be called the HIT Standards Commitee and HIT Policy Commitee. Details on these committees and the type of stakeholder representation on the commiteeis outlined in the notice listed below.

After seeing the notice I pushed it out to a variety of health colleagues via Twitter asking the question, “Who would you nominate?” The viral social networking nomination process was off and running and a Health Twitterstorm was started with many responses and recommended nominees. To view the process check out the tag #NominateHIT.

Jen McCabe Gorman (@jenmccabegorman) started to aggregate potential nominees to be submitted by the deadline of March 16. She has generously offered to coordinate the response and submit them to the ONC.

So far the results of potential nominees:

• First Batch of Nominees
• Second Batch of Nominees
• Third Batch of Nominees (with instructions on what Jen plans to do with the submissions)

A number of people asked about my nominees so I thought I would add them here. Here goes in no particular order (if you find your name below and want to be considered please forward your information to Jen McCabe Gorman here):

Jane Sarasohn-Kahn, Health Economist, Health Populi

Christopher Parks, CEO of change:healthcare

John D. Halamka, MD, MS, CIO CareGroup Health System, Chief Information Officer and Dean for Technology at Harvard Medical School

Scott Shreeve, CEO ofCrossover Healthcare

Josh Lemieux, Markle Foundation

Jay Parkinson, MD, Hello Health

Jen McCabe Gorman, Health Management RX

Matthew Holt, Health Care Strategist and Co-Founder, Health 2.0

Jonathan Bush, CEO of Athena Health

Peter Neupert, VP Health Solutions Group, Microsoft

Roni Zeiger, MD, Product Manager, Google Health

Enoch Choi, MD, Partner, Palo Alto Medical Foundation, MedHelp.org

Marty Tenenbaum, Health 2.0 Accelerator Visionary

David Kibbe, Senior Advisor American Academy of Family Physicians

Amy Tenderich, Writer, Blogger, Consultant, Patient Advocate www.DiabetesMine.com

Adam Bosworth, CEO of Keas

REMEMBER:
Change Doesn’t come from Washington. Change comes to Washington.
President Obama

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the National Coordinator for Health Information Technology; HIT Standards Committee and HIT Policy Committee Nomination Letters

ACTION: Notice on letters of nomination.

SUMMARY: The American Recovery and Reinvestment Act of 2009 (Act), Public Law 111–5 amends the Public Health Service Act (PHSA) to add new sections 3002 and 3003. The new section 3003 of the PHSA establishes the HIT Standards Committee to make recommendations to the National Coordinator for Health Information Technology on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information for purposes of health information technology adoption. The HIT Standards Committee members are to be appointed by the Secretary of the Department of Health and Human Services with the National Coordinator taking a leading role. Membership of the HIT Standards Committee should at least reflect the following categories of stakeholders and will include other individuals: providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy
and security, and on the electronic exchange and use of health information.

In addition, we also seek nominations to the HIT Policy Committee (established by the new section 3002 of
the PHSA), which makes recommendations to the National Coordinator on the implementation of a nationwide health information technology infrastructure. The HIT Policy Committee will consist of at least 20 members. Three of these members will be appointed by the Secretary of the Department of Health and Human Services. Of the three members, one must be a representative of the Department of Health and Human Services and one must be a public health official. If, 45 days after the enactment of the Act, an official authorized under the Act to make appointments to the HIT Policy Committee has failed to make anappointment(s), the Act authorizes the Secretary of HHS to make such appointments. The Department of Health and Human Services is consequently accepting nominations for the HIT Policy Committee. New section 3008 of the PHSA allows the Secretary to recognize the NeHC (if modified to be consistent with the requirements of section 3002 and 3003 of the Act and other federal laws) as either the HIT Policy Committee or the HIT Standards Committee. At this time, the Department of Health and Human Services is evaluating options regarding the National eHealth Collaborative and its role in relation to those Committees. For appointments to either the HIT Standards Committee or the HIT Policy Committee, I am announcing the following: Letters of nomination and resumes should be submitted by March 16, 2009 to ensure adequate opportunity for review and consideration of nominees prior to appointment of members.

ADDRESSES: Office of the National Coordinator, Department of Health and Human Services, 200 Independence Avenue, NW., Washington, DC 20201, Attention: Judith Sparrow, Room 729D.

E-mail address:
HIT_FACA_nominations@hhs.gov.
Please indicate in your letter or e-mail to which Committee your nomination belongs.

FOR FURTHER INFORMATION CONTACT:
ONC/HHS, Judith Sparrow, (202) 205–4528.
Authority: The American Recovery and Reinvestment Act of 2009 (Pub. L. 111–5), section 13101.
Dated: March 9, 2009.
Robert M. Kolodner,
National Coordinator for Health Information Technology, Office of the National Coordinator for Health Information Technology.
[FR Doc. E9–5391 Filed 3–9–09; 4:15 pm]
BILLING CODE 4150–45–P

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The administration has relied in large part on a RAND study claiming savings of $80 billion a year through the nirvana of what Wall Street Journal reporter Anna Wilde Mathews caustically referred to as "whizbang computer systems." The President cited the $80 billion figure again during the White House health-care summit last week.

Or, as White House press secretary Robert Gibbs asserted, "The health IT in the economic recovery plan will make health care more affordable, will save patients' lives, and increase the quality and the outcome of the health care that millions of people are provided."

He might want to take a mulligan. As a series of reports this week make clear, the bloom is coming off the rose.

Writing in the Wall Street Journal, Harvard Medical School faculty Jerome Groopman and Pamela Hartzband debunk the received wisdom, noting:

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

It's not, they conclude. And they are not alone.

The RAND study has been sliced and diced fairly regularly now by, among others, one Peter Orszag, now the White House budget director.

Last May, when Orzag was director of the Congressional Budget Office, CBO examined the Rand report and a parallel study concluding they "appear to significantly overstate the savings for the health care system as a whole — and, by extension, for the federal budget." Summing it the CBO findings, Orzag concluded that while the technology, in combination with other moves, may help reduce expenses, "by itself it typically does not produce a reduction in costs."

Another report from Avalere Health, quoted by the Associated Press this week, concludes it will cost providers far more to implement the golden goose systems than they will get back in return.

Using government cost estimates, Avalere researchers found that it would cost about $124,000 for a single doctor or small practice to upgrade to electronic health records over the five year period from 2011-2015 when the stimulus bill offers incentives to do so.

But the total incentive payments a doctor could get over that time period only add up to $44,000. In 2015, penalties start to kick in for doctors who haven't switched to electronic record-keeping. But in one scenario mapped by Avalere, the starting penalty would be $5,100 a year — far less than how much it would cost to install and maintain an electronic health system.

In other words, a pig in a poke. And, that's just the supposed financial benefits.

Registered nurses have long raised alarms that some of the technology may be intended to displace staff or an RN's professional judgment, which is especially critical with the complex medical conditions seen in the patients who get through the hospital doors these days, and said those billions could be better spent on actual care delivery.

Many doctors, like those in the Journal report, are speaking out now as well. Groopman and Hartzband note "there is no evidence that electronic medical records lower the chances of diagnostic error." And they point to studies that raise further doubts. For example:

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems."

Another such warning came from MD Scott Haig this week in Time who describes the frustrations of doctors who are forced to use such systems "or risk losing our hospital privileges" if they don't.

Yet some big hospital chains are spending billions of dollars for the high tech hype with despite the lack of evidence it will produce either cost savings or improved healthcare.

Haig wonders who is really behind it. the new digital world order, and concludes:

Not surprisingly, nationwide adoption of Electronic Medical Records is being pushed hardest by those who would profit financially from it. The slightly embarrassing financial reality of EMR is that large, mechanized medical operations like hospitals, clinics and big multi-doctor practices stand to make quite a bit of money by adopting them — given our current convoluted system of paying for health care. Two clear factors make EMR a money-winner: improved billing and internal cost control.

And, there's another hook for the insurers here, Haig notes:

Computerized medicine means both more information — and less medicine. Less therapy, less surgery and less testing too. That's how it saves money. A variety of promising terms describe it — terms like targeted treatment, algorithmic patient-care, fiscally responsible medicine and evidence-based practice — but for doctors treating patients, one word describes how computerized records save money. Denial. EMR has the potential to greatly increase insurance company denials of the tests and treatments that doctors order.

Big profits, for the tech corporations that manufacture them, and the software companies that design them. Better bill collection for the hospitals. Improved billing, and fewer nettlesome claims for the insurers whose first priority is always receiving payment, not actually paying for care. Who would have guessed? A boondoggle for some, it looks like, and misplaced priorities for the rest of us.

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