Leavitt's vision: HHS Secretary Mike Leavitt seeks a moretransparent, interoperable healthcare system

Mike Leavitt is an idealist with a practical slant. As secretary of the Department of Health and Human Services (HHS) since January 2005, he would like to establish a national, interoperable health information system. He firmly believes that innovative technology can improve the quality of care in the United States, better inform consumers about health costs and quality, and slow down the nation's healthcare spending spiral.

But he also recognizes that realizing this "pure vision of interoperability" requires a lot of mundane work to set standards and adopt protocols. Leavitt considers U.S. railroads an apt model. The early lines all had rails with different sizes. "To get a national system, we needed common rail gauges," Leavitt explained during an interview with MANAGED HEALTHCARE EXECUTIVE. "The same is true for health IT."

Starting small

Although the ultimate goal is to develop a perfectly integrated healthcare system where vital information can be transmitted in a secure manner to multiple authorized entities, Leavitt recognizes achieving that "pure vision" requires many small steps to demonstrate that success is possible. In pursuing a realistic approach to implementing health IT, HHS is collaborating with other federal agencies and private organizations to identify several "low-hanging fruit" initiatives. Working groups under the American Health Information Community have developed recommendations in several breakthrough areas:

Leavitt plans to implement those projects this year by using the federal government's "payer power" to generate support. Medicare, Medicaid, the Department of Defense, the Veterans Administration and the federal Office of Personnel Management will adopt standards supporting these programs, and they will request that all their providers do the same. Ultimately, health plans and providers that want to do business with Medicare or other federal healthcare programs may be required to implement these kinds of health IT programs.

"We're going to be asking a lot of private payers and insurance companies to join with us," Leavitt explains. "We know that when a large segment of the market moves, it moves the market."

More collaboration

Leavitt emphasizes that public-private collaboration on IT standards is important for making progress. "It's not good enough for the federal government to just decide on a method and implement it, because we may decide on the wrong thing," he says. "We have to bring the private sector into this process." At the same time, he realizes that government leadership is critical. "Once it became clear that the federal government would put its buying power behind these standards, people came to the table," Leavitt says.

He considers the American Health Information Community critical to reaching conclusions about which standards to adopt and which approaches to implement. Although the panel is set to expire after five years, Leavitt hopes that it will become a self-perpetuating mechanism that will provide a forum for all parties to agree on standards and terminology and build support for their adoption.