On Wednesday, I joined the Annual AMIA Policy meeting and participated in a debate of the question
"Recent increases in HIT funding, public awareness, and Federal policy, if sustained, are sufficient to enable vibrant informatics research and development efforts that will assure innovation and progress in clinical informatics for the future of health and health care."
Don Rucker and I were asked to argue on behalf of the question
Here were my arguments.
What do we need to ensure innovation and progress in clinical informatics?
1. Policy drivers that create a business value case. Implementation and adoption of informatics will be sustained if there is a business case to do so. ARRA/HITECH and ACA have created the necessary policy drivers. Meaningful use provides 3 stages of functionality with increasing amounts of data exchange, decision support, and innovative informatics from 2011-2015. Healthcare reform brings new kinds of data aggregation, quality analysis, administrative simplification., and decision support to increase the efficiency of healthcare - all of these drive informatics demand. Finally the work of the Privacy and Security Tiger Team has given us a framework for consent that is an enabler to innovative uses of data.
2. A well defined technology stack
The Standards and Certification final rule provides content, vocabulary and security standards needed for healthcare information exchange. NHIN Direct and NHIN Connect provide transport standards. The new Standards and Interoperability Framework using the NIEM process provides a means to add new standards as needed to meet the demands of use cases.
3. Funding
SHARP grants, HIE/REC Grants, Comparative Effectiveness funding, Center for Innovation in Medicare and Medicaid Services funding, and direct payments to providers/hospitals provide more than $30 billion in resources.
4. Governance and Processes to support innovation - the HIT Standards Committee, the HIT Policy Committee, and NCVHS provide Federal Advisory Committees that are open, transparent, public forums for prioritization of projects and resolution of controversies.
5. People - there are many types of professionals needed to ensure progress in clinical informatics - fellowship trained MDs and PhDs, AMIA 10x10 trained informaticians, certificate program trained implementers/practice consultants. The National Library of Medicine funds 400 fellows at 20 locations to ensure the country has a pipeline of fellowship trainees. AMIA's online resources have trained countless informaticians. ARRA funds include $118 million for certificate programs.
Thus, we have policy, technology, and funding initiatives which are sufficient to ensure innovation and progress in clinical informatics. Governance and a pipeline of trained professionals will ensure the foundation built today evolves to meet future needs. It's a great time for clinical IT. Never before in history have so many factors been aligned for success.
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