Reporter’s Notebook: Market Forces Aren't Working


WASHINGTON — Last week’s Fourth Health Information Technology Summit was a much smaller affair than the previous one last September, since the fall event doubled as the annual conference of the eHealth Initiative.

This one brought out a few big-name speakers and some interesting pronouncements, but no groundbreaking news — in contrast to the last one, which hosted the first public speech of Robert Kolodner after he was named interim national coordinator for health-IT. (See “Dr. Robert Kolodner Appointed Interim National Health-IT Coordinator.”) Instead, we got snippets of news and a lot of hints.

The most anticipated speaker, Google vice president Adam Bosworth, was more style than substance.

Kolodner came back again, mostly giving an update from his appearances at the Healthcare Information and Management Systems Society (HIMSS) conference a month earlier. After a deputy said at HIMSS that the second round of National Health Information Network (NHIN) contracts would go to end users rather than systems integrators, Kolodner talked here about a future “Phase Three” of NHIN development.

More than six months after his appointment, Kolodner retains the “interim” tag, and his detail from the Department of Veterans Affairs has been extended. There has been some talk, though none from any official sources, that Kolodner could remain national coordinator through the end of the Bush presidency in January 2009. If true, he would hold the spot longer than his non-interim predecessor, David Brailer.

According to Kolodner, the third phase of NHIN development will look at “tangible progress” that health information exchange is making toward improving both health and care. (Kolodner likes to separate healthcare into two distinct but complementary entities.) His Office of the National Coordinator for Health Information Technology (ONC) will try to advance the NHIN to “trial entries,” with the goal of fostering competition in the marketplace.

“Market forces aren’t working in healthcare right now,” Kolodner said, pointing to the current lack of information for patients to make informed choices.

ONC still plans on soliciting bids for Phase Two starting later this month. (See “Next Round of HHS Contracts Will Go to Users.”)

Meanwhile, the Centers for Medicare and Medicaid Services is supposed to release a report on a pilot project to advance electronic prescribing, according to Jon White health-IT portfolio manager of the Agency for Healthcare Research and Quality’s (AHRQ) Center for Primary Care, Prevention, and Clinical Partnerships. And by mid-April, AHRQ will issue a request for information on stewardship of healthcare data, a key issue standing in the way of widespread health information exchange, White added.

As Kolodner put it, health information exchange must take privacy, security, and confidentiality seriously. “If we violate that, we set ourselves back for years,” he said. “We will lose the trust of the public.”

Meanwhile, the standards harmonization process soldiers on. In May, Health Level Seven’s version of the EHR-Lab Interoperability and Connectivity Standards (ELINCS) will go to a vote, said John Halamka chairman of the Healthcare Information Technology Standards Panel. Halamka added that the panel should finish its work on standardization of personal health records before the end of the year.

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