The Commission on Systemic Interoperability hopes to move the country toward a fully functional, fully distributed EHR (electronic health records) system, Wallace said. The most obvious controversy concerns who should pay for it.
Rather than address that issue immediately, the commission needs to examine how IT impacts the quality of health care, Wallace said. The issue is to define "what are the benefits, quantify those benefits, and then attribute those benefits to the respective groups that receive them." That process will shape how the costs of IT should be covered, he said.
Other challenges include deciding ways to measure quality and delivering the technical support necessary for broad adoption.
The necessary discussions, including how to measure quality, need to occur in a public setting, Wallace said. Unlike ONCHIT (the Office of the National Coordinator for Health Information Technology), the commission is authorized to hold public hearings and so can generate a large public record. The commission can approach issues from a private-sector perspective. "The value well deliver to the Congress is to deliver a spectrum of advice," he said.
He credited another organization created to advise policy makers, the IOM (Institute of Medicine), with stimulating widespread interest in health IT. A series of IOM reports and events have put medical errors in the spotlight.
"The only way to solve this problem is to address the systemic issues," Wallace said. "Were killing people because of poorly designed health care systems, and improvements in those systems are heavily reliant on tools and reliance on information technology."
The major problems will not be technical ones, he said. "Theyre not at all technical issues. Theyre readily solvable from a technical point of view. Its just an issue of leadership and commitment."
The future of health IT is "ever brighter, and expectations have never been higher," Wallace said. And now, he said, "those higher expectations are being backed by leadership."
"There is a very solid commitment to address them. And it will continue whether or not theres a change of administration. Its too critical to the economics of health."
Though the commissioners were not all appointed until recently, the provision for the Commission on Systemic Interoperability predates the creation of ONCHIT. Per terms set forth for the commission in the Medicare Modernization Act, the 11 commissioners, listed below, are named by the president and by congressional leadership.
- Don E. Detmer, M.D., president and chief executive of American Medical Informatics Association; appointed by Speaker of the House Dennis Hastert (R-Ill.)
- Vicky Gregg, CEO of BlueCross BlueShield of Tennessee; appointed by Senate Majority Leader Bill Frist (R-Tenn.)
- C. Martin Harris, M.D., chief information officer of the IT division at the Cleveland Clinic; appointed by President Bush
- Gary A. Mecklenburg, president and CEO of Northwestern Memorial Healthcare, appointed by Speaker of the House Dennis Hastert (R-Ill.)
- Arnold Milstein, M.D., medical director of the Pacific Business Group on Health; appointed by House Minority Leader Nancy Pelosi (D-Calif.)
- Herbert Pardes, M.D., president and CEO of New York-Presbyterian Hospital; appointed by Senate Minority Leader Thomas Daschle (D-S.D.)
- Thomas M. Priselac, president and CEO of Cedars-Sinai Medical Center; appointed by House Minority Leader Nancy Pelosi (D-Calif.)
- Ivan Seidenberg, CEO of Verizon; appointed by Senate Majority Leader Bill Frist (R-Tenn.)
- Frederick Slunecka, CEO of Avera McKennan Hospital; appointed by Senate Minority Leader Thomas Daschle (D-S.D.)
- William W. Stead, M.D., director of the Informatics Center and associate vice chancellor for health affairs at Vanderbilt University; appointed by President Bush
- Commission chairman, Scott Wallace, CEO of the National Alliance for Health Information Technology; appointed by President Bush.