Q&A with Mike Leavitt

In 2004, President Bush launched a sweeping initiative to promote the development of a nationwide system of health information technology. One key goal is to provide every citizen with access to an electronic medical record by 2014. Health and Human Services Secretary Mike Leavitt helms this gargantuan effort, which aims to bring together the private and public sectors to create the technological infrastructure for the healthcare system of the future.

Q: Is President Bush’s 10-year plan for electronic medical records on track?

{mosads}I believe that will be accomplished. I think the goal may be exceeded. There will be a point where this begins to happen quickly. That’s the way technology develops: there are some early adopters, the mechanism has to be put into place, people begin to catch the vision. Once the consumer begins to see its value, it spreads quickly.

Q: Other than electronic medical records, what are the key components of a fully wired, interoperable healthcare system?

I think it’s important to remember that the goal here isn’t electronic medical records. The goal is to transform the sector of healthcare into a system of healthcare, a system that provides consumers with information about the quality and the cost of their care. …

Interoperability essentially means one computer system being able to talk to another. … If you were to take five different systems that are different sizes and different complexities, they don’t need to do everything the same.

They simply need to do a limited number of functions the same.

Q: What will be the biggest advantages to better incorporating information technology into the healthcare system?

In the long run, it will provide better health, lower costs, fewer medical mistakes and a lot less hassle. … It isn’t just because it’s a tidier way to do business. It’s because it produces value.

Q: All three of the presidential candidates’ healthcare reform plans depend in part on health IT saving money. How much money could be saved through the efficiencies that should come from using these technologies?

The RAND Corporation did a study that said … there was a 30 percent inefficiency in the costs. I’m not predicting a 30 percent reduction, but I do believe that over time we can begin to have medical inflation more closely approximate regular inflation. If you could make that change in the glide pattern or the slope of growth, it would make a profound economic difference.

Q: Since the administration’s effort began, what’s done and what’s still to be accomplished?

We developed a process for developing standards that incorporated the medical family, developers of technology, government entities, insurance companies, et cetera, and have now instituted a means by which those standards are emerging. We also created a process for certifying systems that meet those standards. …

If interoperability was two feet long, we’d be at about the six or eight inches mark. Next year, we will be at eight or 10 inches. Each year, we’ll get a little closer to interoperability. …

The next challenge is to lay in a system for a national health information network, where information can be transported between systems. We will see live data transmitted over that system in September. We’ll see real data begin to flow early next year. …

A second area of real challenge is in adoption among small- and medium-sized physicians’ [practices]. … We have to change the macroeconomics of medical reimbursement so that everyone benefits. We have just announced and will conduct a Medicare demonstration project that will help us learn how to do that.

Q: What have been the biggest obstacles that have kept the healthcare system so behind the curve on IT compared to the rest of the economy?

First of all, it’s far more complex than any other sector of the economy. If you look at banks, for example, they’re highly interoperable but they deal with a very basic measure, and that’s the dollar. … [I]t’s easier than if you’re having to develop the means of managing all of the conditions and the information that goes into healthcare. … It’s also far more segmented.

Q: Why is it important that the federal government be involved in this process? Why can’t the private sector be left to develop this system on its own?

I believe the government has a role, and it’s to be that of an organizer of the system. We have a role not just in our capacity as regulators but in our capacity as a payer. … There’s no one else who has that amount of influence. …

The private sector will be developing the technology. We simply need to provide the basic standards that they can build into the technology so that it can communicate with other technology that may be developed independent of them.

Q: What are the key legislative changes that Congress should consider in the near term?

It’s vital that Congress support the standards-development process that we have in place that’s now working and that any legislation they do points toward that, as opposed to competing with it.

The second thing I would point to is e-prescribing. That’s a logical next step. …

I think a third area would be in helping us leverage our power as a payer to encourage the adoption of electronic medical records. …

The fourth one is, one of the real virtues of electronic medical records is the ability to define quality and cost in a way that’s usable for consumers. The most important tool in doing that is information from claims data. Right now, we have two federal courts that are conflicting on the use of Medicare claims data. … We need legislation to resolve that dispute.

A complete transcript of this interview can be be viewed here .