HIStalk Interviews Jennifer Bordenick, CEO, eHealth Initiative

Jennifer Covich Bordenick is CEO of eHealth Initiative and the eHealth Initiative Foundation of Washington, DC.

Tell me about yourself and eHealth Initiative.

I’ve been working in health care quality technology for about 18 years. I started out working at a hospital. I worked with health plans and did QA for a number of years along with technology organizations. I started at eHealth Initiative about eight years ago and was appointed as CEO last January.

We are a non-profit, non-partisan membership organization. Our mission is to drive improvement in health care through the use of health IT. We educate, research, and advocate for the use of health IT to improve quality of care.

We’ve got about 210 corporate members. Some of them are influential groups in HIT. We are multi-stakeholder, so we’ve got clinicians, labs, vendors, and hospitals. Everybody is on board. We’re not really beholden to anybody, which makes it nice. We’ve got a nice multi-stakeholder consensus when we are advocating for a position.

I should probably also mention we’ve got the Connecting Communities Coalition, which is a group of about 260 regional, state, and local initiatives that work on health information exchange.

eHealth Initiative had a big part in getting healthcare IT into the stimulus bill.  I noticed that not many more than half of your 2010 follow-up survey respondents said care delivery had improved as a result. Is this going to be like England’s NPfIT or will taxpayers and patients eventually see a return on investment for all these billions?

Gosh, I hope not. I mean, it’s incredible that the federal government made this significant investment. It would be to all of our benefit for this to work, so I certainly hope this works. I think a good number of things are going to come out of it. So what’s the question exactly?

For folks who aren’t seeing the quality improvement, how do we know we’ll see it at some point?

I think the one thing you can say is that we’re going to start measuring it. We haven’t measured it before. If there are improvements, we’re going to see if there are. If there aren’t improvements, we’ll see that there aren’t any improvements. One of the things you can’t do is you can’t improve if you can’t measure it. So I think that’s the first thing — that we’re going to start doing that.

In terms of the money hitting the system and when we’re going to see the improvements from the federal investment, I would imagine that’s going to be two years down the line because the money hasn’t come out yet. But I do think that the market has already started to move significantly and it’s significantly accelerated the adoption of technology.

People are talking about it. When I started doing this 15 years ago, it was not cool. Nobody new what health IT was or HIT. Now there’s a sense out there that is important, and not just that this needs to happen, but that it has to happen.

A couple of years ago we were really fighting and advocating and trying to prove to Congress and to the market why you should do this, why you should invest in this. Now we actually have the investment. So now it’s kind of, how do we do this to make sure that it works?

Most of the poster children for health IT have been organizations that already did it without having the government help pay for it, bigger organizations like Kaiser. Is there concern that maybe this doesn’t scale down to the vast majority of providers that aren’t as big or as savvy as a Kaiser?

I think that’s a valid concern. I mean, the folks that have been successful in the past are the names that we’ve all heard of. But it’s like any new field or industry. You always have those early adapters.

I think that we’ve seen just in our survey of Health Information Exchange over the last seven years … we’ve seen the numbers grow and grow. Especially in and industry that is growing and learning from itself. I think you’re going to see more names up there. There’s definitely more technology out there now and more successes stories then there were eight years ago.

A lot of the incentives encourage people to buy systems that are already out there that they had already passed on. Is there a concern that all of this came about before the whole concept of health care reform? We’re putting out a lot of automation just as we’re changing the goals as we realign care in a different direction around Accountable Care Organizations or whatever the next attempt to make it better will be.

Well, actually, if you look at the legislation and you look at what’s really happening, it’s complimentary, because you can’t move to Accountable Care Organizations unless you have an infrastructure that supports data and technology. I mean, you just can’t get there. You can’t coordinate care unless you can connect those organizations and identify those patients. You can’t do any of that without the electronic infrastructure. So you really need one to get to the other.

I think HITECH and the stimulus package create a foundation to build these changes on and the payment adjustments and the bundling and all that’s going to come about because of health care reform. If you look at the timing as well, the health IT changes should start to kick in before the ACOP. In theory, they should compliment each other.

A survey came out recently suggesting that hospital CIOs are less optimistic that they’ll be able to meet the Meaningful Use requirements. Are you worried that there may be enough skeptical providers out there that the incentives won’t be enough?

Yes, I am. I think the timing on this is quite aggressive. I think there are a number of folks that aren’t going to attempt this in 2011. I think there will be a number of folks that will just wait and hang on. I think we’re going to see a bigger number of folks for this in 2012 once the ground has cleared.

So yes, I don’t think anybody can look at this program and say it’s not aggressive. It’s incredibly aggressive. The timelines are aggressive. Everybody’s concerned about resources, money, and time.

You mentioned HIEs. It seems that there are still questions about if they’ve really found a business model that will work once the grant money runs out. What’s your thought on how HIEs fit into the picture?

My thought is that health information change initiatives have been around for a number of years. I mean, we’ve been tracking them for eight years. This program, the state-designated entity, just started this year. You’ve got 56 new state-designated entities that we’re just starting to track now. But even before they existed, there were groups out there doing this. I don’t think one is reliant on the other.

Your point as far as sustainable business model is incredibly valid. This has been the number one challenge every year when we survey folks — getting the model. The issue with health information exchange it’s a public utility and it helps everybody. So who pays? It’s a really difficult thing to figure out. What’s the right business model for that?

EMR vendors have been successful in basically having their products mandated, without any penalty or downside for them except having to pay for certification. Will they see any negative impact from the movement as opposed to all the positive impact they’ve seen so far?

It’s like any other product. People are going to buy it or they’re not going to buy it. If it’s certified or not, if the customer feels that it’s meeting their needs, if the physicians feel it’s the right product, they’re going to continue to buy it.

Despite the fact there’s a mandate, there’s a lot of competition out there and there’s a lot of vendors to choose from. Hopefully like anything else it will just move the way the market is supposed to move and people will compete.

The investment timeline is short. Does it inhibit competition and innovation by encouraging the purchase of systems that were build long before HITECH, possibly eating up provider budget money that could have been spent on more innovative systems that might not even be on the market yet?

I think there’s a fine line between standardization and innovation. We have to deal with it throughout this program…I will say there’s dozens and dozens of products that have been certified. So I think that there are a number of groups out there. There’s all the old favorites that we’ve all heard of but, there’s also a lot of new ones there. It might not create completely level playing field, but I do think there’s still opportunities for innovation.

What does it mean that we now have two big insurance companies that have bought HIE technology vendors?

I think they realized the need for an infrastructure for data and quality. They maybe positioning themselves for the ACOP piece, which is coming up. I think there’s a real recognition right now that people need to invest in data and quality. You can’t do a lot of the stuff without the data. I can’t comment too much on that because I don’t too much about the specifics. I just know probably what you know.

The issue about the data is who’s controlling it and with what kind of privacy and security. We know that some vendors have decided it’s OK for them to sell de-identified patient data without individual patient approval. We’re also trying to build a national framework around a set of individual state laws. 

I think what you’re getting at is the privacy and information sharing issues, which is of great concern to patients, providers, and everybody. Who owns the information? Who can you share it with? Who can look at my information? That’s a really valid issue and I think that’s important.

As far as whose technology creates the infrastructure … just because a road is built by a certain company, does that mean you’re not going to want to drive down that road? Probably not. We’re talking about HIEs, the infrastructure or the wires that are going to connect all these different pieces together. What’s going to be most important is the laws and regulations around privacy information sharing and not who owns it. Who created the technology, not whose application it is.

But when people start talking about technology, they’re all for it until they start talking about healthcare privacy, which brings out a lot of emotion. Will we ever figure how to ease the fears of patients about their medical data?

I think that we overcame it with banking. People exchange all kinds of information on the Internet right now, especially if you look at the younger generations. People put all kinds of stuff out there on Facebook and Twitter. I think there’s a different set of concerns growing up with each generation. I think that we are going to be able to adjust to privacy issues.

I think that the other thing is that people want mobility and convenience. Everybody wants the app on their iPhone that allows them to refill their prescription with the press of a button. People want that convenience, and I think at some point that’s going to override some of the other issues.

HITECH is mostly about making providers more efficient or more effective. Do we have a vision of population health, things like obesity, personal choices, chronic disease management, and lack of access to care that has nothing to do with making doctor encounters more efficient?

This is really the golden opportunity. This is the stuff that really excites me. Having the data to find a cure for cancer. It’s all about population health. And once we have the identified data where we can actually look at what works and what doesn’t work, I mean, it’s going to be incredibly valuable to all of us. I think everybody kind of understands that’s going to be good thing.

Part of the problem is that we really need to drive the agenda and the message and win the communication battle that’s going on here. We really need to be able to explain to patients and help patients understand health IT and how it’s a good investment and a smart investment. It’s going to make your care better. It’s going to help us find cures for diseases. This is a good thing. I think that’s the battle that everybody’s engaged in right now with a lot of this.

Do you think consumers are interested in that discussion?

I think that there are consumers that are interested. Like anything else, it’s the people that have the most interaction with the system. If you have a chronic care condition or if you have a lot of doctor’s appointments or you have children like I do, you’re always at the doctor’s office. You know there are convenience issues. There are real issues about your care. The more interaction that you have with the health care system, then the more screwed up you realize it is. I mean, let’s be honest.

So I think that, yes, we can explain this to people. I think it makes sense to people once they understand the issues. There’s always going to be privacy concerns. There are always going to be privacy advocates that say, “You shouldn’t do this.” There’s still people that say, “You shouldn’t do banking online” or “You shouldn’t use Amazon.com because somebody might get your credit card information.” There’s always going to be that element and that group that’s concerned about it. But we can’t let that … we have to deal with the issues and figure out what the policies are going to be surrounding that. Then we have to move forward.

You said something I agree with, that the value of HITECH is to get providers on the data grid so really useful things can be done with population data analysis, which is happening with Kaiser. Do you think the idea has been sold well that the HITECH benefits may be more societal than individual?

No, I don’t think it’s been sold well at all. I think that the message has not been clear. I think it hasn’t been loud. I think that we can all do a better job with that.

There aren’t enough examples out there for people to say, “Oh, I get it” or say, “I understand now — you need my information so you can figure out that this medicine works really well for people with my condition.” You know there’s not a lot. We don’t talk about that. 

That’s so important. There’s not a lot of people unless you interact with the health care system a lot who realize that, “Oh, OK, this is why my doctor’s EHR needs to talk to my specialist EHR — so I don’t have to lug my images across town to the radiologist. So they can get them and look at them and shoot back the results to me.” People either have to have a close interaction with the health care system or they have to have a more profound idea of why this is needed for the greater good. We haven’t done a good job of that.

I would think you are encouraged by what Kaiser has done, making it a cornerstone of their strategy and communicating in clear terms what they’re doing and why.

Yes, I think they’ve done some good pieces. I think United has done a couple of good commercials. There are definitely groups that are trying to do that. But more of us need to do that. It has to get down to the doctor’s level. The doctor has to understand why this important and be able to explain it the patient while they’re in their office.

What do we follow HITECH with?

What comes next? [laughs]. I think the data will reveal a lot. If we can figure out how we’re doing out there, that will lead us in the direction we need to go in. We’ll be able to see where we can improve, make care better, see where care is bad, see who’s doing it right and who’s doing it wrong. I think that’s really important.

I also think healthcare reform and the payment structure … that’s really the bottom line. If we can’t figure those out, we’re all going to be stuck in this hole for a long time. We’ve got to get to that point, and I don’t think we can without data. It’s going to be hard to argue why it’s needed unless we have clear-cut data. Payment reform is important and data is important.  

The one time that was tried with mammography, there was an uproar by patients who felt they were entitled to mammograms and providers whose income was threatened even though the information was scientifically valid. Can we ever separate politics from healthcare enough that all this data can be used to make objective decisions?

Gosh, we have to. People don’t want politicians in their bedrooms and they shouldn’t want them in their exam rooms, either. I think it’s really important that we find a way to keep politics out of it. HITECH was bipartisan. Republicans and Democrats agreed on this health IT stuff. For us to all of a sudden disagree on that – that would be really sad because I think both sides see the need for it. I hope we’ll be able to get through this.