Much more recently the President's Council of Advisors on Science and Technology(PCAST) issued a similar "think different" challenge to the healthcare technology industry and to the government leadership for health IT, contending that internet technology advances can help to address a number of critical issues for the healthcare system.
PCAST frames its case for change as follows:
- The healthcare system structure limits incentives for care coordination, information sharing and cost reduction.
- The current structure of health IT systems makes it difficult for providers and patients to access and use needed health information across organizationas and across various settings of care.
- There are limitations of exchange standards and infrastructure for information sharing across organizations, including information on data provenance
- The limited data exchange also hampers researchers and public health agencies access to information needed for comparative effectiveness and biomedical research.
- Current health information exchange effectiveness is burdened by administrative requirements and has not proven their ability to scale out nationally.
- Patients' privacy preferences for their health information are not sufficiently built into the existing standards
The PCAST recommendations include:
- "Accelerate progress toward a robust exchange of health information.
- Establish a new exchange architecture with a universal exchange language (UEL) and interlinked search capabilities coupled with strong privacy and security safeguards. The exchange architecture will enable clinicians and patients to assemble a patient's data across organizational boundaries and facilitate population health.
- Establish an evolutionary transition path from existing installations to the new exchange architecture."
The PCAST end state vision includes three components:
- "Every American will have electronic health records and will have the ability to exercise privacy preferences for how those records are accessed, consistent with law and policy.
- Subject to privacy and security rules, a clinician will be able to view all patient data that is available and necessary for treatment. The data will be available across organizational boundaries.
- Subject to privacy and security rules, authorized researchers and public health officials will be able to leverage patient data in order to perform multi-patient, multi-entity analyses."
- Synthesizing and analyzing the public comments and expert testimony regarding the PCAST report;
- Discussing the implications of the report and it’s specific recommendations to ONC on current ONC strategies;
- Assessing the feasibility and impact of the PCAST report on ONC programs;
- Elaborating on how these recommendations could be integrated into the ONC strategic framework.
- "The PCAST report describes a national use of advanced technology. It provides a compelling vision for how that technology could be beneficially used as an important aspect of the learning health system.
- There are major policy and operational feasibility concerns with the proposed technology.
- Aggressive and rapid progress is possible only with an incremental test-bed approach. Large operational tests are needed that resolve the policy and feasibility concerns."
And in a philosophical conclusion (Gandi-esque perhaps?) , the Workgroup contends that:
"The ultimate challenge is to find the correct balance between the inspirational goals of the PCAST report and the practical realities of a nationwide deployment of electronic health records. We respectfully submit this letter hoping that it will assist ONC in achieving that balance."