Chopra Outlines Health IT and Technology Goals

Now, there’s more of a view that many of the improvements America wants to make to its healthcare system will be facilitated by technology, Chopra said. That idea -- of making IT part and parcel of reform efforts -- underlies every agenda item on the president’s priority list, including health care, education, energy and jobs, Chopra said. A large part of Chopra’s job is weaving technology into those policy discussions, he said. He’s also charged with pushing technology-based innovation, ensuring a robust, reliable and secure infrastructure, and bringing the potential of emerging technologies into the government to increase openness and transparency, he said.

Chopra said he’s eager to see the new business models that could emerge as a result of the Recovery Act spending on health IT. He said that will be a “significant accelerant” given that current health IT revenue comes out to about $25 billion per year and the Recovery Act includes incentives of about $19 billion. “The broad question for me is, if we do this correctly, what does the overall industry health look like?” he said. Will Recovery Act spending mean increasing consolidation or will it prompt a wave of venture-backed startups? Will the jobs be traditional software, installation and support jobs, or will any entirely new type of worker emerge? Health care is at the very beginning of harmonizing, analyzing and utilizing data in the way retail does, he said.

There are basically two ways the government can push health IT and innovation, Chopra said. It has procurement and grant-making power and its funding of research and development, he said. Chopra has ideas for both those areas, but he plans to spend most of his time in the gray area between them, he said. That could mean X-prizes or innovation grants, he said, but he will advocate for a place for innovation. “Innovation by RFP is absolutely silly,” he said. The iPhone, with all its capabilities and apps, would never have been created through a request for proposals, he said. He pointed to defensesolutions.gov as a good idea. At that site, the Defense Department posts a simple description of a problem it’s trying to solve -- for example, it needs a battlefield forensics kit that will test for explosives, drugs and gunshot residue -- and asks for short summaries of ideas. That’s instead of hundreds of pages of department description of specification and hundreds of pages in response. The department can then ask the creator for additional information, Chopra said, and eventually strike a deal if the proposal suits its needs.

Chopra is also charged with ensuring a reliable, robust, next-generation infrastructure, and security is a big part of that. “Now that I have been given my top-secret clearance … I am even more aware of the challenges we face and the threats coming our way,” he said. Health care needs to start thinking about how it will provide security, he said. Will it continue to rely on dumbed-down pipes and attempt to build up security at each individual site, or will it migrate to a more robust, perhaps managed-service level capacity, he said. He gave as an example Virginia’s efforts. There, he said, the state was using dumbed-down infrastructure because it was cheapest, and each of the 150 agencies was building up their protection individually. Then-Governor Mark Warner decided the system had to change, he said, and “moved the challenge upstream” by getting a dedicated network.

Chopra also promised to use technology to make government-collected information as easy as possible for others to use. For example, in an article in the New Yorker, surgeon Atul Gawande was able to use Medicare data to show that McAllen, Texas, which spends twice as much per person in Medicare as the national average, was over-utilizing services with no measurable improvement. That information is publicly available, Chopra said, but institutions don’t commonly use it to evaluate their performance.