The U.S. CTO says that the federal government is tapping private innovation to meet the needs of better health-care service for Americans. Excerpted from “Will Health-Care IT and Telemedicine Lead to Better Treatment, a Healthier Population and Reduced Medical Costs?,” August 18, 2010.

ANEESH CHOPRA, United States Chief Technology Officer

The Affordable Care Act passed in the spring. We had in the bill a requirement to [set] up a web site by July 1, and that web site was meant to simplify what the health reform bill would mean to the American people. It particularly called out a usable catalogue of all the available health insurance options that might be available in your zip code, in your community.

I hope by now the two words that matter most in the health-care sector, in the relationship between technology and health care, are “meaningful use.” This is the term of art that has been introduced into the nomenclature. But you might be wondering, What does that mean? In July of this past year, I’m pleased to report we published a final set of rules of what it is to be a meaningful user of health-care IT; broadly speaking, it means that providers do the following five things: focus on quality, safety and efficiency in health care; engage patients and families; coordinate with other stakeholders in the ecosystem; focus on improvements to public and population health; and do so in a manner that respects privacy and security.

I want to deep-dive on one of those categories, to give you a flavor for what this entails. On patient engagement, there are four specific provisions in meaningful use: One: Patients are entitled to timely access to an electronic copy of their data. Two: A clinical summary should be made available after every visit. Three: Alerts and reminders for preventive and follow-up care should be made available. Four: Electronic access to patient-specific education resources should be a part of the equation.

To be fair and to be honest, the framework allows some flexibility, so providers may mix and match which of the 25 components of meaningful use they wish to apply for. So a subset, perhaps 20 of those 25 conditions have to be met. Not all providers will focus on these four provisions in patient engagement. But with your participation and your agitation and inspiration and empowerment, perhaps that will be the way our ecosystem will adopt moving forward.

I now [want to mention] the connectivity realm, and that is to focus on data interoperability. Our core flagship program in this regard is the Nationwide Health Information Network. I will focus on the CONNECT program, which is the technological underpinnings – the open-source collaboration – that is encouraging public and private stakeholders to come together to promote the safe secure exchange of health data. What is exciting about this program is not just the technical advances they’ve made, but the process they’ve chosen to adopt to move the ball forward. This is an open collaboration by design. Every quarter we are hosting a code-athon, where [software] developers from the the private, public and academic sectors come together to gather and understand the latest challenges that are confronting the need for the CONNECT [open source software] program and that they can come together and develop applications that are all freely available for reuse again by the private and public sectors.

Does this nationwide health information network deliver results? Our first adopter in this program was the Social Security Administration, and they had an administrative-use case. It is unfortunate that those who suffer from a disability have to wait a significant amount of time to process their disability applications with the Social Security Administration to get the services they need to live a healthier life. Thanks to the Nationwide Health Information Network CONNECT program, I am pleased to report in our pilot program a 42 percent reduction in processing time compared to the statewide average for those in the analog environment – where the case worker in the Social Security administration calls for the medical record, asks for the copy to be sent or faxed in, it’s then not complete, they call back for more data, and so forth. Those providers that are in the CONNECT program – where they can electronically communicate the data that’s necessary – have their judgments rendered instantly.

It also means we establish more nimble collaborations to execute for how data should flow in the near term. For those of you who follow those 25 meaningful use requirements I referenced a minute ago, it turns out that the core technical requirement to achieve meaningful use is essentially safe secure e-mail. The ability for the provider to send data to the patient, send data to the referring doctor, send data to the public health department, and so forth. A doctor in public testimony said very vividly, “I have a patient in Virginia moving to Arizona. That patient has luckily chosen a doctor who has the same software that I have, and that patient asked if an electronic copy of her record could be transmitted to that doctor in Arizona. We all said this is the right thing to do. I went to the software,” this doctor said, “and there was no button that said ‘Send data to colleague.’” They had to export the patient’s file, attach it to regular e-mail, send it over the public Internet, open the file, import it into the system, and guess what? It actually worked! But the privacy and security heart attack that was heard in the room when testimony was rendered – that that’s not secure – lead the doctor to say something very simple: “Will you give me a technical spec to allow me to safely and securely e-mail that patient’s record so that I can achieve this patient’s very simple request?”

We said we will focus on this problem, we will execute. We launched the Nationwide Health Information Network Direct Collaborative using an open platform, a wiki – anybody could contribute, public sector, private sector, I don’t care. Anybody who wants to play, you’re welcome to come. However, you have 90 days to turn around a technical spec through a voluntary consensus manner that will give a safe secure e-mail. Over 80 vendors and stakeholders participated. In 90 days the collaboration, with very little government involvement – we simply did convening and hosted the web site – the private sector achieved consensus around a spec that will achieve this objective. This program will be, I believe, widely deployed in the spring, so [health-care] providers can communicate safely and securely to achieve the meaningful use requirements by 2011.

This is a spirit of entreprenuership and innovation that we’re bringing to the pubic sector, and it’s born out of a very simple policy lever: not government as rule maker, not government as grant writer; government as convener. Bringing people together and encouraging them to find solutions that are in the spirit of the common good. Every one of you can visit nhindirect.org, learn about the specs, participate with the specs, offer to operationalize the spec.

You want secure and simple? I’m going to go even one more on the simple framework. I had the honor and privilege of listening to the president’s remarks in August when the president announced to the disabled veterans of America: By this fall veterans will be able to go to the VA web site, click a simple blue button and download or print your personal health records so you have them when you need them and can share them with your doctors outside of the VA. The [Centers for Medicare & Medicaid Services] program and the [Department of Defense] have joined this movement. While we look to have a framework for secure health exchange, lets start with basic rights to your data. We start with government as model actor; we will provide our recipients the authority to have and control of their own health data. A flat file that they can download and I hope that others will make it available so they can import that file wherever they want

The taxpayers have paid for data that sits in the proverbial file cabinets in Washington, that if released could actually deliver value in ways we can’t even imagine. Secretary [of Health and Human Services Kathleen] Sebelius convened a forum at the Institute of Medicine where we formalize the launch of the Community Health Data Initiative.

We asked a half a dozen entrepreneurs, Could you improve or add new applications born out of the data at HHS that could spur health improvement at the community levels? Our first customers, Microsoft, Google and entrepreneurs all demonstrated their wares. The example is Microsoft said, You have a quality database called Hospital Compare, this has a wealth of information; for example, we track your patient satisfaction on how well you slept at night in the hospital room. I gave my remarks this [topic] on New York City and we did the analysis. Not a single hospital in New York exceeds 50 percent satisfaction rates on how well you slept at night? I had no idea. Microsoft said, In our Bing search engine, if someone searches for a hospital, in the search results we will bake in the data from hospitalcompare.hhs.gov, so you have it right at your fingertips. We don’t really care or measure success on how often you visit a government web site. We measure success by how much impact the data has in your lives. By opening up the data, Google, Microsoft and others have said, We can find new and creative ways to bring the data to you. I don’t care if you get it from Bing or Google or whatever. I care that you are empowered with that information.

Typically government spends money in two traditional ways; we issue grants or we issue procurements, solicitations. Our challenge is, How do we establish frictionless participation? We established a policy framework encouraging our agencies to use prizes and competition policy. The First Lady was the first one to sign up and she said that she wanted to incorporate a prize in her Let’s Move campaign to address the issues of childhood obesity, and one of the key pillars of her program is to close the information gap.

I don’t know what I’m eating from a nutritional standpoint. So we said something very simple, the Department of Agriculture has a database of 30,000 food items. How might we find a more creative way to bring that information to life? We issued a simple challenge; 95 applications responded to our call, where we only had maybe $60,000 in prize money available. Those applications have been screened. I had my wife and my three-and-a-half-year-old play these games to tell me which ones are better, because I’m a judge in the contest. One example of these applications was Smash Your Food, where you basically create a meal, you smash the food and it provides you the sugar, the salt, the oil intake data that might help you understand what this means for your own nutritional choices. It’s so cool. It’s actually not that cool, because my wife yelled at me about the meal I had the other night; she actually saw the game and said, wait a minute, that’s not healthy.

We also acknowledge the importance of advanced information technology infrastructure, and there’s no IT infrastructure more relevant to health care than our commitment to a mobile broadband revolution. It’s happening in ways we couldn’t even imagine. In February [2009], I had the pleasure of celebrating an open collaboration called Text for Baby. Again, at zero cost to the American taxpayer, we launched a service that basically had a very basic proposition. If you’re pregnant and you want relevant information to keep yourself healthy through pregnancy and over the first year of the child’s birth, text 511411, your due date, and you will receive three relevant messages a week free of charge. This collaboration got the cell phone companies to wave their fees, got the content companies to offer their data, got the Centers for Disease Control to say let’s take a look to make these messages adhere to best practice, and already in less than six months, over 60,000 people have signed up for this service. Not a nickel of taxpayer dollars. Simple, easy ideas.

We’ve got a policy framework, we’ve got grassroots activities, we hope we’ve gotten this right, and if we haven’t, we’ll course correct with your feedback.

Question and answer session with TOM NESBIT, associate vice chancellor of strategic technologies and alliances, UC Davis Medical Center

NESBIT: Expand on what you feel the role of early-stage entrepreneurs is in this, as well as small companies in helping us realize this vision of a technology enabled health-care system.

CHOPRA: I believe innovations will largely come out of our entrepreneurial ecosystem, and that the health-care sector more than any other is in desperate need of innovations. I am hopeful that our policy framework will tap into those small businesses and entrepreneurs so that they are encouraged and incentivized to participate in the system. There’s core infrastructure – the role of government here, to support through infrastructure, getting the policy framework right in terms of the reimbursement roles in some of those challenges, setting constraints so that we’re not harming patients, that is why we get the regulatory framework right, we’ve got the privacy and security provisions. All of that is designed to catalyze breakthroughs.

NESBIT: Are there lessons to be learned from other countries and how they’ve implemented technology into their health-care systems?

CHOPRA: Absolutely. In fact, our national coordinator for health IT, Dr. David Blumenthal, who is a rock star, is not only leading this effort with a gusto, he is also engaging internationallly. I had the pleasure of visiting Spain during its tenure as the head of the [European Union] and had the chance to address their digital summit, where they talked about a European digital agenda. I’m pleased to note that health IT interoperability ranks among their top priorioties and that we are actively looking for collaborations on how we might exchange best practices.

NESBIT: There’s been made a considerable financial and political investment into the idea that technology’s going to transform our health-care system. What are the greatest barriers to realizing this vision?

CHOPRA: I would cite three barriers. The biggest barrier is ensuring that we have the right ecosystem that would enable or encourage these applications to thrive. The second barrier is the need for innovation. The bottom line, more fundamental barrier, is if patients don’t trust that the system will allow for the security and privacy of their data – game over. We are absolutely laser-focused on ensuring that the best thinking on privacy and security are coming to the table for this topic.