EHRs: Do the feds have a real plan to digitize medicine?

The office that President Bush created to promote interoperable EHRs has received $200 million since 2004, but still hasn’t produced a meaningful strategy to attain its goal, according to the General Accountability Office. But a plan is supposedly in the works.

The Bush administration created the Office of the National Coordinator for Health Information Technology, or ONCHIT, as a part of the Department of Health and Human Services in 2004. It was the same year that Bush announced that he wanted every American to have an EHR by 2014. Since then, ONCHIT has racked up several important accomplishments, according to written testimony

submitted to the Senate budget committee earlier this month by Valerie Melvin, director of human capital and management information systems issues at the GAO. Melvin wrote that ONCHIT has funded efforts to certify EHRs, define standards to ensure that these programs can exchange data, create prototypes of health data networks, and keep data confidential without making it too hard to share.

However, Melvin concluded that ONCHIT has failed to “develop a national strategy that defines plans, milestones and performance measures” for reaching Bush’s goal of interoperable EHRs. Without such a detailed plan, the activities of the National Coordinator are uncoordinated, and progress toward the EHR promised land is hard to measure, she stated.

Reminders to get it together apparently haven’t helped much. Melvin wrote that the GAO had recommended in 2005 that ONCHIT develop a comprehensive roadmap for its work and had reiterated that point twice in 2006. ONCHIT says it will release a “Health IT Strategic Plan” in the second quarter of this year. The GAO will presumably give it a grade on effectiveness.

In her testimony, Melvin didn’t attempt to explain why ONCHIT hasn’t been a model of planning. She might have explored the subject of continuity of leadership. Internist David Brailer, the first person to fill the job of National Coordinator, was appointed in May 2004 only to resign in April 2006 (the following year, he helped launch a $700-million private-equity firm focused on health technology and services). The National Coordinator position was empty until psychiatrist Robert Kolodner was appointed on an interim basis in October 2006 (he gained a permanent appointment in April 2007).

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