The Most Powerful Person in Healthcare IT

Who is the Most Influential Person in Healthcare IT?

It was not immediately clear, at least to me, that HITECH would have the effect it has. By that I mean it would utterly and completely transform the healthcare IT industry. It took me some time to realize that, through Meaningful Use, the government’s stipulations of what it would take to earn the incentive funds would de-facto become the five-year strategic plan of almost every hospital, and many eligible providers, in this country.

So Meaningful Use, essentially, defines what’s going on in almost every aspect of the industry. It is with this in mind that I’ve been compelled to delve into the nuances of how that concept is being defined.

At first blush, most will say, “We know how it’s being defined. There is a Policy Committee and  Standards Committee, and we know exactly how those committees were put together.” Technically, that’s true, but any student of human dynamics in group settings will know that while, on paper, one may think each individual has equal input, reality is quite different. Each body has its rules of governance and those who know them can make their influence exponentially larger than those who do not. Sometimes, it’s a matter of being on subcommittees and workgroups, sometimes a matter of chairmanships.

There are also other factors to consider. For example, how much time can an individual devote to the group’s workings? Let’s say the group is made up of volunteers. Some of those people may hold demanding jobs, while the jobs of others essentially call for them to exert the greatest possible influence on the committee they are volunteering for. Some may be experienced in the workings of such groups, and thus more facile at turning suggestions into policy, while others may simply be looking to offer input, unconcerned about whether it is incorporated into what eventually becomes policy. In short, the influence of people appointed to the same committee can be vastly different based on their experience and intent.

So in an effort to identify the most influential and powerful person in healthcare IT, we must look at HITECH, Meaningful Use, and the HIT Policy Committee. Once at that committee, we must delve deeper into its substructure, which contains workgroups that perform the nitty gritty policy making before it’s passed to the full committee, often for quick review and approval. Only rarely are well-baked recommendations sent back to workgroups for revision. The Policy Committee’s workgroups are:

  • Meaningful Use
  • Certification/Adoption
  • Information Exchange
  • Nationwide Health Information Network (NHIN)
  • Strategic Plan
  • Privacy & Security Policy
  • Enrollment
  • Privacy & Security Tiger Team
  • Governance
  • Quality Measures
  • Quality Measures – Tiger Teams
  • PCAST Report

One measure of an individual’s influence is how many of these workgroups he or she sits on. A quick review shows those who sit on at least five workgroups are:

7 – Paul Egerman, Retired Software Entrepreneur (Co-Founder of IDX, eScription)
7 – Christine Bechtel, National Partnership for Women & Families
6 – Carol Diamond, Markle Foundation
6 – David Lansky, Chair, Pacific Business Group on Health
5 – Charles Kennedy, WellPoint
5 – Deven McGraw, Center for Democracy & Technology
5 – Latanya Sweeney, Carnegie Mellon University
5 – Neil Calman, Institute for Family Health
5 – Paul Tang, Chair, Palo Alto Medical Center

Keep in mind, there seems to be no limit to how many workgroups a committee member may volunteer for, which means the original intent of having somewhat equal representation among a collection of industry stakeholders can be thrown way out of balance by the eager and energetic. This can be illustrated by thinking of the number of workgroups participated in as votes for the constituency each individual represents, and many have very identifiable constituencies with definite agendas.

At this point, I’m going to apply some subjective impressions from listening to many of the FACA meetings, hearing how the individuals above participate — do they speak much, are they leading the conversation, do they often challenge what’s said by others, do others seem to respect their opinion? Are they content to offer opinions and fade back, or do they seem intent on turning their positions into policy?

Based on the above considerations, we can now reduce the list to the following individuals:

7 – Paul Egerman, Software Entrepreneur
7 – Christine Bechtel, National Partnership for Women & Families
5 – Deven McGraw, Center for Democracy & Technology
5 – Neil Calman, Institute for Family Health
5 – Paul Tang, Chair, Palo Alto Medical Center

But, of course, not all workgroups are created equal. To further refine our quest for the most powerful person in healthcare IT, let’s look at which of those workgroups to consider “Power Groups.” To me, those are Meaningful Use, Quality Measures and Privacy and Security (along with the Tiger Teams of the latter two). It is in these workgroups where most of the Meaningful Use sausage is being ground.

Let’s now go with the premise that you cannot be the most powerful person in healthcare IT without being on the Meaningful Use workgroup. In that case, we are left with four names:

Christine Bechtel, National Partnership for Women & Families

  1. Meaningful Use (Power Group)
  2. Quality Measures (Power Group)
  3. Quality Measures Patient & Family Engagement Tiger Team (Power Group)
  4. Privacy & Security Tiger Team (Power Group)
  5. Governance
  6. NHIN
  7. Strategic Plan

Paul Tang, M.D.

  1. Meaningful Use (Chair, Power Group)
  2. Privacy & Security Policy (Power Group)
  3. Quality Measures (Power Group)
  4. Quality Measures Patient & Family Engagement Tiger Team (Power Group)
  5. Strategic Plan (Chair)

Neil Calman, Institute for Family Health

  1. Meaningful Use (Power Group)
  2. Privacy & Security Tiger Team (Power Group)
  3. Quality Measures (Power Group)
  4. Quality Measures Patient Safety Tiger Team (Power Group)
  5. NHIN Workgroup

Deven McGraw, Center for Democracy & Technology

  1. Meaningful Use (Power Group)
  2. Privacy & Security (Power Group)
  3. Privacy & Security Tiger Team (Power Group)
  4. Information Exchange
  5. Strategic Plan

When the final four are compared, the outcome is clear. Sitting on seven workgroups, four of which are power groups — and possessing a forceful will to place her imprimatur on Meaningful Use — the most powerful and influential person as it relates to the development of healthcare information technology policy in the United States is Christine Bechtel.

Now, we must look at Bechtel and her organization. Bechtel is VP of the National Partnership for Women & Families, an organization focused on promoting, “fairness in the workplace, reproductive health and rights, access to quality affordable health care, and policies that help women and men meet the dual demands of work and family.” The organization states is a “nonprofit, nonpartisan 501(c)3.” Prior to joining that organization in July 2008, she was VP of the eHealth Initiative, another non-profit organization.

In early April 2009, she was appointed to the HIT Policy Committee by Gene Dodaro, acting comptroller general and head of the Government Accountability Office as one of the 13 appointees he was required to make. Specifically, she filled one of three “advocates for patients or consumers” slots.

In terms of her group’s agenda, a very declarative sentence on the organization’s site reads loud and clear:

” … the National Partnership (of Women and Families) has been among the most powerful voices in this debate and has worked to ensure that the definition of ‘meaningful use’ in the first phase of the health IT Incentive Program contains criteria that will advance patient-centered care. Bottom line: Health providers who take federal incentives for health IT adoption will be accountable for using health IT in ways that result in noticable improvements in the care you receive.”

The tone of this sentence, its guarantee and demand that those who receive HITECH funds will have to really, really earn them pervades her comments and presentations. One can also literally see the bolded passage above hanging over everything that has come out on Meaningful Use so far.

So there we have it. Not the American Hospital Association, American Medical Association nor the American Academy of Family Physicians runs Meaningful Use. Not HIMSS nor CHIME. Through its VP Christine Bechtel, the National Partnership for Women and Families is the most influential group shaping healthcare IT policy in this country.

I, for one, have continually written that the Meaningful Use bar is being set far higher than it should be, far higher than what was intended by Congress when HITECH was written into ARRA. I wonder if Congress intended for the players above to be the dominant voices crafting Meaningful Use.


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  1. rschleichert says:

    Outta the park. Nice work.

  2. rschleichert says:

    Looking at the Board of the National Partnership for Women & Families, I would guess Ms Bechtel is doing the bidding of others.

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