A nationwide, interoperable, privacy-protected health information technology infrastructure. If you think it just can't be done, talk to Nashville's Jonathan B. Perlin, MD. He's a believer.

 

President Obama's American Recovery and Reinvestment Act includes a $19.5 billion investment with the goal of interoperable HIT by 2014. Perlin is the chair of the new federal Health Information Technology Standards Committee, charged with making critical recommendations regarding electronic health records to the National Coordinator for HIT.

 

At the committee's first meeting in May, Perlin divided the members into three workgroups charged with tackling clinical operations, quality, and privacy and security. Those priorities are no surprise when you examine Perlin's background. He is president of Clinical Services and chief medical officer for HCA. Before joining the hospital giant in 2006, Perlin was under secretary for Health in the U.S. Department of Veterans Affairs. He holds a master's of science in health administration, and received his Ph.D. in pharmacology (molecular neurobiology) with his M.D. as part of the Physician Scientist Training Program at the Medical College of Virginia. Nashville Medical News talked to Perlin about the challenges of his new federal appointment.

 

HHS Health Information Technology Standards Committee

• Chair Jonathan Perlin, Hospital Corporation of America
• Vice Chair John Halamka, Harvard Medical School
• Dixie Baker, Science Applications International Corporation 
• Anne Castro, BlueCross BlueShield of South Carolina 
• Christopher Chute,Mayo Clinic College of Medicine
• Janet Corrigan,National Quality Forum
• John Derr,Golden Living LLC
• Linda Dillman,Wal-Mart Stores Inc.
• James Ferguson,Kaiser Permanente
• Steven Findlay, Consumers Union
• Douglas Fridsma,Arizona State University
• C. Martin Harris,Cleveland Clinic Foundation
• Stanley M. Huff,Intermountain Healthcare
• Kevin Hutchinson,Prematics Inc.
• Elizabeth O. Johnson, Tenet Healthcare Corporation
• John Klimek,National Council for Prescription Drug Programs
• David McCallie Jr.,Cerner Corporation
• Judy Murphy,Aurora Health Care
• J. Marc Overhage,Regenstrief Institute
• Gina Perez, Delaware Health Information Network
• Wes Rishel,Gartner Inc.
• Sharon Terry,Genetic Alliance
• James Walker,Geisinger Health System

NMN: It's certainly difficult to keep up with all the different pieces of the bureaucracy being brought to bear on this HIT issue. There's the Office of the National Coordinator, your Standards Committee, a Health IT Policy Committee, the National eHealth Collaborative, the Certification Commission for HIT. Well, I could go on.

 

Perlin: It would take an operetta in three parts to explain all the acronyms. You're right, this is a time when there's a lot of activity, but everyone recognizes that we need to move to a higher value of healthcare. The unifying piece is a movement toward producing better value. Across industries, information technology has really transformed productivity, quality, safety, and we're frankly behind in healthcare. What's so critical is for people to get engaged in the change process. At the end of the day, whatever our politics or professions, all of us and our families are prospective patients. This is the 10^th anniversary of the publication of "To Err is Human," and I think we have to admit we can do better.

 

NMN: Let's start at the beginning. Define standards for me.

 

Perlin: Great question. The standards really refer to a number of specifications that define data types as well how data and information are transported, as well as activities around security. So standards at one level may define what constitutes a simple blood test or a blood pressure reading. Standards at another level may define how information is transported from Point A to Point B. Standards at still another level may define a use of different pieces of data for quality reporting. And standards finally at another level may define how that data is appropriately protected.

 

 

NMN: Obviously, entrepreneurs in the HIT space are watching your committee closely. Is it your committee's job to establish an HIT framework and then let entrepreneurs fill in the blanks?

 

Perlin: The HITECH legislation (stimulus funds for HIT) and the Office of National Coordinator and the Policy Committee and the Standards Committee are all part of a design that we hope encourages innovation. Developing clarity around standards and developing clarity around meaningful use help define a space that entrepreneurs and innovators can work within to advance healthcare and advance novel approaches to the challenges we face in healthcare.

 

 

NMN: With your background, I'm going to take a guess that you're pretty familiar with the VA's VistA program, probably the nation's first successful electronic health record. Are you taking lessons from that?

 

Perlin: I was privileged to have spent nearly a decade in Washington. When the secretary of Veterans Affairs challenged me by asking what would be the most important thing that could be done to improve safety, quality and value, our decision was full deployment of the electronic health record.

 

I think the most important lesson I learned in VA is that it's critical to engage all the people who use health records in the development and implementation of health records. We spent an awful lot of time and invested a lot of work in making sure that we understood what would help physicians and nurses and pharmacists. The reason that it worked so well in VA is because of all of that involvement.

 

I think there's another lesson as well: in VA, the patient also ultimately had a personal health record. One of the areas that was transformative was the view that information really belonged to the patient. … Care providers of today, and especially tomorrow, are going to be working with patients who will expect the ability to access their health information electronically and securely.

 

NMN: Certainly, hospitals face a challenge, but for smaller physician practices, the move to HIT is particularly tough. Do you think that the stimulus incentives (including $44,000 over five years) offered practices are enough to turn the tide? Perlin: You know, it's interesting. In my past experience, I remember the testimony of physicians who implemented electronic health records. Almost invariably, they said it was difficult, but all said they would not go back to paper. We didn't have any physicians whom we interviewed as part of the exploration process who said they'd go back.

 

I think what's changed are a couple of things: First, there are new approaches and new software that's more user friendly. Second, we are seeing the emergence of a new category of software, and that's software as a service. … It's a whole lot easier to use, it's magnitudinally easier to set up and it's substantially less expensive. So the world is changing.

 

What's also exciting and particularly relevant to the incredible healthcare community in Nashville is that this is a great opportunity for entrepreneurs and innovators who can present physicians with better ways of using electronic health records.

 

NMN: And certification for these new systems?

 

Perlin: To be sure, the certification process is evolving, and it will include interoperability as one of the features in the future. The software is getting better, and it's easier to use. I do appreciate the substantial change in practice, but I would hope that the real attraction, the real appeal, is not just the incentive dollars, but the ability for healthcare providers to be more effective in the care of patients.