1. Physician, ACO, HITECH – The Squeeze Is On
by Jim Bloedau of Information Advantage Group
In an excellent and lengthy overview article in Health Affairs by Dr.
Mark Frisse, the Accenture Professor of Biomedical Informatics at
Vanderbilt University, the challenge facing the new leader at ONC
is to maintain the momentum of the HITECH effort as more
experience with reform effects the goals, methods, and public's
perception. He sees HITECH's future being determined by: an
aggressive timeline's ability to deliver; meaningful innovations; and
the seasonal political and economic environment of Meaningful
Use. His observations about realities faced include:
 Transformation: To transform care you need to transform the culture - large enterprises have such skills
and resources, but for many other smaller providers, such methods are not as abundant.
 Innovation: Again large enterprises have the resouces to deploy disruptive innovations like EHRs, while
smaller or less sophisticated providers do not have the experience and resources required for
transformation and innovation.
 Meaningful Use Politics: The debate is polar - those who think you can push reform through by
regulation verses those who believe that market pressures will create the best response to health
reform initiatives and a more honest reality.
Entities large and small have a very full plate -
HIPAA, ICD-10, Meaningful Use, HIE, EHR/EMR,
ACO, financial viability are but a few pressing needs.
Add to this that Medicaid enrollment will increase
under reform and with per capita growth in the
number of physicians being relatively flat for the past
decade, 40% of U.S. primary care physicians
currently considering leaving their field and those
remaining increasingly not choosing to treat new
Medicaid patients, how will some reform efforts not
blowup? Increasingly, the literature is showing good
results and that meeting increasing patient volume and needs is being met by reformulated care teams
that incorporate greater participation by Home Health,companion services, remote care technology, the
patient and caregivers in the ACO/Medical Home model.
As leadership changes at the ONC, it's time for them to consider how to help providers complete all of this
by picking the low hanging fruit in a time of growing fiscal restraint and not try to transform too
much merely by regulation.