While perusing some very old blog posts, I saw Brian Ahier‘s PCAST ~ Where it all began… article with it’s link to the original President’s Council of Advisors on Science and Technology (PCAST) Health IT Report announcement in July, 2010. This led me to the PCAST Report itself and it’s collateral documents and impacts. If anyone wants the full PCAST Report journey, here are the bread crumbs that I followed:

• Minutes of the PCAST meeting, July 16, 2010.
• Video of PCAST meeting, July 16, 2010 at Brian Ahier’s blog.
• The PCAST Report: Realizing the Full Potential of Health IT to Improve Healthcare for Americans: The Path Forward.
• Video of Secretary Sebelius presenting the PCAST report to the HHS constituency via Brian Ahier’s blog.
• Office of the National Coordinator for Health Information Technology’s Health IT Policy Committee’s PCAST Report Workgroup Meeting Materials.
• PCAST Report Workgroup member and vice chair of the Health IT Standards Committee Dr. John Halamka’s many blog posts about the Workgroup’s activities and considerations.

Much has already been written about the details of the PCAST Report. Here are a few summary points:

First, President Obama asked PCAST how health IT could improve the quality of healthcare and reduce its cost, and whether existing Federal efforts in health IT are optimized for these goals. The response to the President’s request comprise the broad landscape and deep analysis of the PCAST Report.

The Executive Summary of the Report lists the potential benefits of Health IT:

Information technology (IT) has the potential to transform healthcare as it has transformed many parts of our economy and society in recent decades. Properly implemented, health IT can:

• Integrate technology into the flow of clinical practice as an asset, while minimizing unproduc­tive data entry work.
• Give clinicians real­time access to complete patient data, and provide them with information support to make the best decisions.
• Help patients become more involved in their own care.
• Enable a range of population ­level public health monitoring and real­time research.
• Improve clinical trials, leading to more rapid advances in personalized medicine.
• Streamline processes, increase their transparency, and reduce administrative overhead, as it has in other industries.
• Lead to the creation of new high ­technology markets and jobs.
• Help support a range of economic reforms in the healthcare system that will be needed to address our Nation’s long­term fiscal challenges.

The Report reached six major conclusions:

1. HHS’s vigorous efforts have laid a foundation for progress in the adoption of electronic health records, including through projects launched by ONC, and through the issuance of the 2011 “meaningful use” rules under HITECH.
2. In analyzing the path forward, we conclude that achievement of the President’s goals requires significantly accelerated progress toward the robust exchange of health information.
3. National decisions can and should be made soon to establish a “universal exchange language” that enables health IT data to be shared across institutions; and also to create the infrastructure that allows physicians and patients to assemble a patient’s data across institutional boundaries, subject to strong, persistent, privacy safeguards and consistent with applicable patient privacy preferences. Federal leadership is needed to create this infrastructure.
4. Creating the required capabilities is technically feasible, as demonstrated by technology frameworks with demonstrated success in other sectors of the economy.
5. ONC should move rapidly to ensure the development of these capabilities; and ONC and CMS should focus meaningful use guidelines for 2013 and 2015 on the more comprehensive ability to exchange healthcare information.
6. Finally, as CMS leadership already understands, CMS will require major modernization and restructuring of its IT platforms and staff expertise to be able to engage in sophisticated exchange of health information and to drive major progress in health IT.

The Report particularly emphasized the advantages of focusing on a universal exchange language:

Briefly, the approach described in this report, focused on the technical ability to exchange data in uniform ways, has multiple advantages:

• It will improve healthcare quality, by making it possible for a physician to integrate accurately all of a patient’s medical information.
• It will improve healthcare quality and decrease costs, by making it possible for third ­party innovators to compete to create widely applicable services and tools serving patients, providers, payers, public health officials, and researchers.
• It will provide much stronger privacy protection than available under current approaches, allowing persistent privacy assurances (including applicable patient preferences) to be attached to different kinds of information and using data ­level encryption to prevent access of data by unauthorized persons.
• It will not require universal patient identifiers, nor will it require the creation of Federal databases of patients’ health information.
• It will simplify the regulatory burden on providers, by decreasing the focus of meaningful use regulations on ad hoc list of data items.
• It will help U.S. industry leapfrog to the front of the pack internationally in health IT, by providing exchange standards that can be more broadly adopted by others.
• It will facilitate public health and medical research, by providing a secure way to de­identify data.
• It will not require that existing systems be replaced, but only be modestly upgraded or augmented by “middleware.”

Following a detailed analysis of the Health IT landscape in the body of the Report, the penultimate Section VIII presents a Guidance to Agencies, including 1) A Feasible Roadmap to the Future, 2) Guidance on Necessary Design Choices and 3) Guidance on Meaningful Use Requirements.

Finally, Section IX of the Report presents PCAST’s specific and comprehensive recommendations to various governmental organizations, including the Chief Technology Officer of the United States, Office of the National Coordinator, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services and other departments and agencies, such as the Agency for Healthcare Research and Quality, Food and Drug Administration, Center for Disease Control, Department of Defense and Department of Veteran Affairs. The details of these recommendations have been much discussed in the trade press and elsewhere, can be found in the Report itself, and do not bear repetition in a brief overview of the PCAST Report.

However, I was singularly intrigued by one particular recommendation in the Report which, as far as I could discover, has not received a single published commentary. The first PCAST recommendation is to the Chief Technology Officer of the United States:

The Chief Technology Officer of the United States should:

• In coordination with the Office of Management and Budget (OMB) and the Secretary of HHS, and using technical expertise within ONC, develop within 12 months a set of metrics that measure progress toward an operational, universal, national health IT infrastructure. Research, prototype, and pilot efforts should not be included in this metric of operational progress.

• Annually, assess the Nation’s progress in health IT by the metrics developed, and make recom­mendations to OMB and the Secretary of HHS on how to make more rapid progress.

The discussion of Recommendations in the Executive Summary near the beginning of the Report is more forthcoming about PCAST’s intent with this particular recommendation, and relates it to the President’s original charge to the PCAST Advisors:

Among our recommendations, we therefore suggest that the Chief Technology Officer of the United States in coordination with the Office of Management and Budget and HHS, develop within 12 months a set of metrics that measure progress toward an operational, universal, national health IT infrastructure that has the desirable features that we have discussed. Focusing these metrics on operational progress, as distinct from research, prototype, and pilot efforts, will enable a more accurate continuing assessment of whether Federal efforts in health IT, including both executive initiatives and legislative mandates, are in fact supportive of the President’s goal of increasing the quality, and decreasing the cost, of healthcare.

In other words, the ONC will, itself along with others, be measured regarding it’s “progress toward an a operational, universal, national health IT infrastructure that has the desirable features that we [PCAST] have discussed.”

Only in these brief paragraphs was there a direct response to the President’s original query of “how health IT could improve the quality of healthcare and reduce its cost, and whether existing Federal efforts in health IT are optimized for these goals” by recommending an “accurate continuing assessment of whether Federal efforts in health IT, including both executive initiatives and legislative mandates, [that] are in fact supportive of the President’s goal of increasing the quality, and decreasing the cost, of healthcare.” Somehow, the most important recommendation responsive to the President’s direct inquiry has been the least noticed, and uncommented particular, in the entire PCAST Report.

In short, the measurers will be measured. In other domains, particularly the software development world, this is called “dogfooding.” That is, the designers being required to use the tools that their users will use to better design them. The CMS meaningful use regulations were designed primarily by Federal Advisory Committees operating under the ONC. While the measurements of ONC will differ entirely from those required by CMS’s meaningful use regulations, the process of being measured should have a similar significant impact on those measured. I am sure that the irony of this particular recommendation is not lost on the hospitals or among the practitioners that are being subjected to the health metrics involved in the regulations implementing meaningful use.

Annual assessment of ONC efforts to support the President’s Health IT goals – that’s Progress!