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Michael  Leavitt, Secretary


Orlando, FL


Tuesday, February 26, 2008

Remarks as Prepared for Delivery to the Health Information Management Systems Society (HIMSS) Annual Conference

Thank you, Victoria, for that warm introduction.

It is always a pleasure to be with you at HIMSS. I enjoyed being with you last March in Louisiana and in New York in 2005. I am always impressed by the size and caliber of the crowd that travels from across the country to attend these conferences. It is a testament to the quality of this organization. You have been pioneers for years, and I applaud your vision and leadership-from-the-front.

On my way in to the convention center today I caught a glimpse of what appeared to be several hundred exhibits. I’ll be visiting some of the booths more closely later. But experience has helped me prepare for some of the things I will see:

  • Devices that will change the way health-care providers practice medicine — so they can manage, sort through, and move information faster, more securely, and more efficiently than ever before
  • Tools to change the way consumers behave — so they can actively manage their health and make better decisions about what care to pursue
  • Innovations that will improve quality of life — from making health care delivery safer to increasing consumer convenience

As I reflect on these advances in health information technology, it occurs to me that the story here isn’t really about technology; it’s about change.

Technology is certainly a key enabler of change. Gutenberg’s printing press changed more than the process for bookmaking — it changed access to education around the world. Automobiles, and the interstates that sprung up under them, changed the way we travel around. But they also changed the way we trade, how cities develop, along with what and how we eat, as strip malls and fast-food restaurants found a market.

It’s clear to me that the world continues to go through many life-altering changes. Most people in this room were alive before we had the Internet, cell phones – even laptop computers. Today, these are common facts of life. We hardly pause to think about them, but we use them and depend on them every day.

Technology again enabled those changes. But I would suggest that the driver of these changes was not technology, it was sociology.

Take banking for example. The technology to secure transactions online came before people were willing to trust that their information would be safe. As they tested the system and understood the benefits of using it, they began to demand the service. Today, every major bank offers online banking services that are generally faster, cheaper, and more convenient than making a trip to a branch.

There are real benefits to be reaped from exchanging information, and this is driving the changes we see.

We know that this is true in health care, too, but change has been slower here.

When it comes to health care, we also know that real harm can come from a lack of access to important information. You all know the studies on medical errors and their attendant human and financial costs.

We also all know that it is universally agreed that health IT has a role to play in making health care safer and more efficient. But to drive the change, we need to make sure that consumers remain confident that their information will be appropriately protected. Robust privacy and security protections will be the underpinning of a successful network for health information exchange.

We have the technical capacity to balance legitimate concerns over privacy with the benefits of appropriate sharing of information. We need to make sure we get this right, and we are working to do so.

The key is trust. And trust is something that is built locally.

People don’t trust Washington bureaucrats to have their best interests at heart when it comes to medicine. I don’t blame them. But they do trust their doctors, their pharmacists, and their communities. That is where the drive for change needs to originate.

That’s one of the reasons I’m here in Orlando today. I will be speaking with health and business leaders in this community later today. Together, we will explore ways for them to build a trusted network that can exchange information in ways that benefit consumers.

There is an important role for the Federal Government in this. In fact, I believe the Federal Government needs to do two things to facilitate connecting the technological advances you are building with the world’s desire to organize into networks:

  1. The Federal Government needs to remove barriers to a connected system.
  2. The Federal Government needs to find ways to incite action at the local level, and then get out of the way.

I’d like to take just a couple of minutes to tell you what we are doing to accomplish those two things.

First, the barriers to a connected system. A principal barrier in the case of health IT is a lack of harmonized standards.

I’m sure many of you are familiar with the American Health Information Community, or AHIC. If not, we’ll be meeting next door in about an hour, and you’re welcome to observe the meeting in person or over the Webcast at

As you may know, the AHIC is tasked with making recommendations to the Secretary of HHS on interoperability standards to allow secure information exchange between different electronic systems. This group has had the support of many partners who have donated countless hours to the process of harmonizing competing standards.

Together, we’ve been very successful. To date, I have officially recognized 50 standards to lay the foundation for interoperability among electronic health records. I’ve also received another 60 recommended standards. These are now undergoing a thorough review within my department so they can be recognized.

Standards are important, but consumers need to know which products use them. That’s why in 2005, HHS contracted with the Certification Commission for Healthcare Information Technology — C-C-H-I-T — to develop a certification process for electronic health record products.

Now an independent, not-for-profit group, CCHIT has certified an estimated 75 percent of the ambulatory products in use today. And last month, CCHIT certified more than a third of the vendors with Computerized Physician Order Entry (C-P-O-E) products for use in the inpatient setting.

A CCHIT seal of approval means that Electronic Health Records (EHR) products and services meet functionality, security, and interoperability standards. That knowledge is important to providers.

Each year, CCHIT updates its criteria for certification. Certification is good for three years. So in 2007 when CCHIT launched its new standards, some ambulatory EHR vendors decided to wait to update their certifications.

They quickly saw that their competitors who had earned a 2007 certification were seeing much stronger sales growth. Now those vendors who waited are coming back to update their certifications.

Now when you look at the big picture here, I would suggest that we have made more progress on standards over the last three years than has been made in the previous 30. But there is still much more to do.

That is why, at the AHIC’s last meeting, I announced the award of a grant to convene the AHIC’s successor — AHIC 2.0.

Our vision for AHIC 2.0 is that it will continue to draw in experts and stakeholders from every corner of the health-care spectrum. But rather than being dependent on federal funding and political prioritization, the AHIC 2.0 will be a broad, public-private collaborative based in the private sector.

It will have its own sustainable business model, and it will be insulated from the direction political winds may blow. And by establishing AHIC 2.0 this year, we can avoid the inevitable pause that would happen during a transition between any two Administrations. This will help us protect, perpetuate, and accelerate the progress we’ve made.

The way forward for this transition will be a key topic we address in our meeting today.

I also mentioned that government has a role to play in helping to prompt local action. I’d like to talk about two initiatives that we are working on at HHS to do just that.

First, in October, I announced a new demonstration project through the Centers for Medicare & Medicaid Services (CMS). In it, Medicare will reward providers who use certified EHRs to improve the quality of care they deliver to patients.

The demonstration project will involve 12 communities throughout the country. To maximize our impact, this project will target primary care physicians in small to mid-sized practices, where most Americans receive health care. This is also where use of health IT has traditionally been lowest.

We expect to involve 1,200 small to mid-sized primary-care physician practices in this demo. That means that 3.6 million Americans will receive better care. Since October, many private insurers have announced similar plans to magnify this effect.

Later this afternoon, I will be encouraging Orlando to apply to be one of the communities to participate in this demonstration project.

Orlando is ripe with small and medium-size practices, and it has a thriving business community. Orlando is not currently participating in any other CMS demonstration project that would preclude their involvement in the EHR demo. As such, we think this community would be a well-suited candidate for this program.

My hope is to see Orlando — and many other qualified candidates — apply to participate in this demonstration by the May 12th deadline.

This demonstration will help to proliferate the standards I talked about in the context of the AHIC. Those are much needed technical standards that will enable many of the changes we’ve talked about. But to bring about change that puts the patient in control of his or her health, we also need standards for quality.

That is why HHS is working with medical practitioners, health plans, payers, and consumers to develop standards of quality and cost in health care delivery. Together, we are essentially building national standards. But in order to develop trust within communities, there has to be local control.

It’s at the local level that these quality and cost measures will be used to bring patients better care. It’s at the local level that trust is fostered to make this successful.

So there needs to be a local organization that can make use of national standards and apply them to local priorities.

This is the second area where HHS is working to inspire local action.

I have been visiting communities around the country that are committed to advancing health IT and engaging in cost and quality measurement and reporting. There are scores of these collaboratives operating at various levels of sophistication.

Late last year we established a structure to identify and begin working with these groups to support their further development. Now, I have been encouraging them to come together formally to launch a Chartered Value Exchange, or C-V-E.

CVEs pull together members of their communities — doctors, pharmacists, insurers, employers, and patients — to exchange quality and price information so they can all find better value.

We received 38 applications, from which 14 collaboratives were selected for the inaugural class. We'll be adding more collaboratives to this group throughout the year.

Soon, members of these CVEs will begin receiving information on their comparative health-care performance from CMS. This information will help consumers, providers, and payers in measuring, reporting, and improving local health-care delivery.

Importantly, as communities become more and more involved in working together to deliver value to patients, the trust they foster will grow. As trust grows, there will be a shift in sociology. Soon, consumers will demand change in a way that drives action.

We expect to see this kind of transformation take place around the country in all of our CVEs.

We have reached an exciting moment in health care. We are at the cusp of truly revolutionary change.

We each have a role to play in this change. Those of you who are innovators are building the technologies that enable bold transformation in the way health care is delivered and consumed. The Federal Government must continue to address the need for standards so that these innovations can link up. And communities must foster the trust needed to drive a change in sociology.

I believe that we are at the cusp of this social change taking place because all three things are happening now.

When I was with you in Louisiana last year, I acknowledged that change is hard. But now more than ever, I believe that an important change is coming. I told you then that there are three ways we can handle change:

  • We can fight it and fail;
  • We can accept it and survive; or
  • We can lead it and prosper.

Today I am here to thank all of you for helping to lead the change to a connected, value-driven health-care system that delivers better care, at lower cost, to all Americans.

Now I would be delighted to hear your thoughts on these topics, so I’d like to invite any questions you may have.

Last revised: August 29, 2008