Medical Device Daily Executive Editor

ORLANDO, Florida – Few American have heard about the universal electronic medical record (EMR), considered the foundation of better healthcare and improved patient safety. When they do, will they trust that their healthcare information will be kept from the prying eyes of government, their employer, their neighbor?

Another question: Does American healthcare really want change – a word we are being pelted with lately?

These questions were not posed exactly this way by Michael Leavitt, secretary of the U.S. Department of Health and Human Services, another presenter in the robust lineup of healthcare information technology (HIT) stars appearing at this year’s annual conference of the Healthcare Information and Management Systems Society (HIMSS; Chicago). But clearly these were the issues he was addressing. And his answer to both was that a “sociological change” is always required to build trust in new technologies, such as electronic medical records (EMRs) and the e-health environment as a whole.

He assured the HIMSS attendees that the technology is available to guarantee privacy of health records, though he clearly was preaching to an HIT choir hopeful that e-health will fulfill its widely promised benefits – and that, as choir members, they will be profitable participants.

Leavitt argued that more than technology is needed to fulfill this promise of not just change, but “real change.”

He offered his father as a case study, a parent who studied every one of his bank statement deposits and withdrawals for months before he was absolutely certain that online banking was exact and safe. Thus, he said, “The story isn’t about technology — the story isn’t about technology change.”

Technology, he said rather, is the “enabler of change” and that the essential requirement is securing broad social trust in the new.

“People worry a lot about the personal information they have. They should,” he said. “Real harm can come when you have personal information that’s exposed. Real harm can come from a lack of access to important information.”

The “underpinning” of a universal health information system, Leavitt said, is “robust protection,” and he assured the HIMSS 2008 attendees that we now have available the “technical capacity to balance privacy concerns with information sharing.”

The necessary trust is “achieved one heart and one mind at a time,” he said.

“People intuitively don’t trust distant bureaucracy, but they do trust locally,” he said, “things they know, people they know,” he added, emphasizing the local nature of building the required trust.

Thus, he said he would be meeting with groups in the Orlando area, “to explore with them the ways for them to build a trusted network that can exchange information that will benefit consumers. We need to remove the barriers to connected systems, and incite action at the local level and then get out of the way so that we can accomplish it.”

Moving to the barriers to developing these connected systems and networks, he cited the “lack of harmonized standards.”

He said that the American Health Information Community (AHIC), a public/private partnership recognized as the official consultant to HHS on HIT, has officially recognized 50 different standards to lay the foundation for interoperability, and has received another 60 standards that it is considering.

Certification of EMRs using these standards is critical for helping consumers select the best products, Leavitt said, and he reported that the Certification Commission for Healthcare Information Technology (CCHIT) has certified “75% of the products on the market today” and that this certification essentially served as a “seal of approval.”

(In an earlier session, Mark Leavitt, MD, chair of the CCHIT – and no relation to Leavitt of HHS – said that the commission has certified more than 100 ambulatory electronic health record products, representing about half of the companies in the market. And a CCHIT survey released earlier in the week reported that 72% of doctors believe that published certification standards will have a positive impact on EHR adoption.)

As an umbrella statement, Leavitt (the Leavitt of HHS) said that government’s role is to “organize the market to go forward and let market forces guide and innovate.”

He also endorsed AHIC as “insulated from the political winds that blow,” and the development of AHIC 2.0 as gearing up to “avoid the inevitable pause that happens any time there’s a change in administrations. We’ve got to launch it, get it going, outside those political winds to accelerate the progress that we’ve made.”

Leavitt identified three other basic things that need to be done moving forward:

• The adoption of e-prescribing, with government providing incentives for this. “The day is not far off,” he said.

• Correction of the “mismatch ... between small- and medium-sized physician groups in the macroeconomic scheme.” And he said that HHS is developing a demonstration project in 12 communities” that will reward physicians in these smaller practices if they use CCHIT-certified EMRs.

• Encouragement of private insurers who need to do similar things “to magnify this effort.”

Leavitt’s “mantra” for the establishment of standards supporting the universal e-health effort, he said, is “national standards but local control.”

“This is an exciting moment in healthcare. Communities can begin to build the trust necessary to drive the sociology to see what’s necessary to occur,” he said. Healthcare, he said, can fight change and fail, accept change and perhaps survive, or “lead it — and prosper.”