On October 4th, 2009, just as the U.S. Supreme Court opens its new term and welcomes new Justice Sotomayor, C-SPAN invites Americans to tour the Supreme Court building and hear directly from the Justices during the network’s newest special feature series, "Supreme Court Week."
The C-SPAN special "The Supreme Court: Home to America's Highest Court," will give an inside look at the nation's top court and the people who sit the bench. Interspersed among the individual interviews with current and retired justices will be a Supreme Court tour with Justice Ruth Bader Ginsburg.
I have written before on the fact that the various Justices have held differing opinions on whether camers in the courtroom are appropriate. While he was still Supreme Court justice, David Souter (who is replaced by Sonia Sotomayor) discouraged any attempts to broadcast Supreme Court proceedings. He used the "camel's nose" theory fearing that once they had even the slightest amount of access, the media would soon gain full access to Court proceedings. Justice Souter once told a House Appropriations subcommittee, “that I can tell you the day you see a camera come into our courtroom, it’s going to roll over my dead body.” Justice Sotomayor seems to be of a different opinion. See below the current and past views of the Justices on allowing cameras in the court.
Justice Sonia Sotomayor
Took Her Seat: September 8, 2009
"I’m a pretty good litigator, or I was a really good litigator, and I know that when I worked hard at trying to convince my colleagues of something after listening to them, they’ll often try it for awhile. I mean, we’ll have to talk together... I would be … the new voice in the discussion. New voices often see things and talk about them and consider taking new approaches."
— Confirmation Hearing, 2009
Justice Clarence Thomas
Took His Seat: October 23, 1991
"I have no objection beyond a concern that the cameras be as unobtrusive as possible…Its good for the American public to see what's going on in there."
— Confirmation Hearing, 1991
"It runs the risk of undermining the manner in which we consider the cases. Certainly it will change our proceedings. And I don't think for the better."
— Testimony before a House Appropriations subcommittee, April 4, 2006
Justice Antonin Scalia
Took His Seat: Septemeber 26, 1986
"I wouldn't mind having the proceedings of the court, not just audioed, but televised, if I thought it would only go out on a channel that everyone would watch gavel-to-gavel. But if you send it out on C-SPAN, what will happen is, for every one person who sees it on C-SPAN gavel-to-gavel…10,000 will see 15-second sound takeouts on the network news, which I guarantee you will be uncharacteristic of what the court does…So, I have come to the conclusion that it will misinform the public rather than inform the public to have our proceedings televised. .They want "man bites dog" stories. They don't want people to watch what the Supreme Court does over the course of a whole hour of argument. People aren't going to do that."
— "A Constitutional Conversation," April 21, 2005
Justice Anthony Kennedy
Took His Seat: February 18, 1988
"My initial reaction is that I think it might make me and my colleagues behave differently than they would otherwise. Perhaps they would be accustomed to it after awhile. The press is a part of our environment. We cannot really excise it from the environment. But in the courtroom, I think that the tradition has been that we not have that outside distraction, and I am inclined to say that I would not want them in appellate court chambers."
"I once had a case in which-it was a very celebrate case in the City of Seattle. And the courtroom was packed. And we were at a critical point in the argument. I was presiding. And a person came in with all kinds of equipment and began setting it up. And he disturbed me. He disturbed the attorneys. He disturbed everybody in the room."
And he was setting up an easel to paint our picture, which was permitted. If he had a little Minox camera, we would have held him in contempt. So, the standard doesn't always work."
— Confirmation Hearings, 1987
Justice Stephen Breyer
Took His Seat: August 3, 1994
When you say start with the video and see how it goes…And be very, very cautious, I think that would reflect my view."
— "A Constitutional Conversation," April 21, 2005
"Let me not talk about the particular case, and let me think about things that were in my mind a year ago, or two years ago, well before that particular matter arose. At that time, I voted in favor in the judicial conference of experimenting with television in the courtroom. That has been carried out. The results are being evaluated."
"In Massachusetts, television is in the courtroom. The Massachusetts judges I've spoken to seem generally satisfied. The results of that are being evaluated in the federal system. My particular appeals court was not part of the experiment, but not for want of willingness; it was because they could only have a small number."
"That's the circumstances in which I think my vote in favor of the experiment was right as of this moment-abstracting from this particular case and putting myself back in the frame of mind I was two or three months ago in respect to this. That's basically my view."
— Confirmation Hearing, July 13, 1994
Justice David Souter
Took His Seat: October 9, 1990
"The day you see a camera come into our courtroom it's going to roll over my dead body."
— Congressional Testimony, 1996
"If the cameras are unobtrusive and are not making sound that is distracting, that's one thing. There is still a risk…Cameras which are obtrusive to oral argument so that they really do distract your attention. That is something that has to be avoided…There's no question there's value there."
— Confirmation Hearings, 1990
Justice Stephen Breyer
Took His Seat: August 3, 1994
"I'd say this, Senator. The issue came up in the Judicial Conference of the United States, of which I was a member. That's the-they have representatives of all the circuits and also the district courts. And I voted in favor of that. We voted to have a television in the-the questions as the Court of Appeals and the district courts and we would run an experimental program. And it's going on now in the district courts, but also in the courts of appeals. I volunteered our First Circuit with the concurrence of the other judges for the program, but we were not accepted as an experimental circuit. So, I have expressed a view that is appropriate in that way in the Judicial Conference.
"Now, I should add that before making any decision about in the Supreme Court of the United states, if that issue arose, obviously I would listen to other members of the Court and try to understand their points of view and what they were thinking, too."
— Confirmation Hearing, July 12, 1994
Saturday, October 3, 2009
Diabetes Rap by Dr. Clarke
Dr. John D. Clarke, AKA The Physician Musician, produced, wrote and performed the H1N1 Rap. His new rap is about how to prevent diabetes. This guy is on a mission to reach "da youts" about a variety of health problems.
Thursday, October 1, 2009
The Patient at the Center
The Planetree of Hippocrates in Kos, Greece
October is Patient Centered Awareness Month. The Tree of Hippocrates has become a symbol of patient centered care. This is the planetree under which, according to the legend, Hippocrates of Kos (considered the father of medicine) taught his pupils the art of medicine. The tree's association with Hippocrates is the source of the name of the Planetree, an organization of hospitals dedicated to personalizing, humanizing, and demystifying the healthcare experience. The Planetree philosophy is patient centered committed to improving medical care from the patient's perspective. Patients are encouraged to read their own medical records. Their pets are allowed to visit. Families are encouraged to participate in the patient's care, and can even prepare the patient's favorite dishes in special kitchens on each floor. In addition to the most modern and technologically advanced Western medical treatments, alternative options such as acupuncture and massage are offered.
At Planetree We Believe...
- That we are human beings, caring for other human beings.
- We are all caregivers.
- Care giving is best achieved through kindness and compassion.
- Safe, accessible, high quality care is fundamental to patient-centered care.
- In a holistic approach to meeting people's needs of body, mind and spirit.
- Families, friends and loved ones are vital to the healing process.
- Access to understandable health information can empower individuals to participate in their health care.
- The opportunity for individuals to make personal choices related to their care is essential.
- Physical environments can enhance healing, health and wellbeing.
- Illness can be a transformational experience for patients, families and caregivers.
"Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebags.... He should get only just so much as is good for him.... It is a terrible thing to take away hope, every earthly hope, from a fellow creature... Some shrewd old physicians have a few phrases always on hand for patients who insist on knowing the pathology of their complaints without the slightest capacity of under standing the scientific explanation. I have known the term 'spinal irritation' to serve well on such occasions."The attitude of Holmes is obviously unacceptable today. Patients increasingly expect to know not only their diagnoses, but also details of pathophysiology, treatment options, and prognosis. These days patients often even challenge their physicians' diagnoses. Patients expect and often demand information that used to be only within the physicians' reach, and physicians increasingly expect that they will share information with patients.
The change in attitude surrounding disclosure of diagnoses stands out when discussing cancer. Not surprisingly, Holmes advocated that physicians avoid the term "carcinoma" when speaking with patients. He would be very uncomfortable at the Celilo Cancer Center where the Planetree philosophy of patient centered care is practiced. Of course there is a delicate balance of keeping hope alive and brutal honesty.
Beyond simply being honest, one argument for informing patients is that information enables patients to participate in medical decisions. In less patient centered days, physicians decided what was best for their patients, and patient participation was limited to compliance with physicians' orders. As the art of medicine becomes more patient centered, participation begins with the patient helping to make medical decisions, and the emphasis will shift from compliance to participation. Including the patient and the entire family in the decision making and care of the patient is important.
Of course, individual patients are different with respect to the amount of detail they want, and the degree to which they wish to participate in decision making. Therefore, the art of patient centered care involves determining the appropriate amount of information and participation from the individual patient's perspective. For some patients, the "right not to know" is a crucial element of patient centered care. For some patients it is not necessarily information that dtermines for them whether they are at the center of their care. The provider must not assume that certain types of patients, based on age, history, or other factors, will favor or disfavor information. This is a part of patient centered care that is very intuitive for the provider.
There is a great deal of interest now in the Patient Centered Medical Home (PCMH). This is a new approach to providing comprehensive primary care. The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PCMH:
Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
Quality and safety are hallmarks of the medical home:
- Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
- Evidence-based medicine and clinical decision-support tools guide decision making
Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement. - Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met
- Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication
- Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
- Patients and families participate in quality improvement activities at the practice level.
Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following framework:
- It should reflect the value of physician and non-physician staff patient-centered care management work that falls outside of the face-to-face visit.
- It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
- It should support adoption and use of health information technology for quality improvement;
- It should support provision of enhanced communication access such as secure e-mail and telephone consultation;
- It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
- It should allow for separate fee-for-service payments for face-to-face visits. (Payments for care management services that fall outside of the face-to-face visit, as described above, should not result in a reduction in the payments for face-to-face visits).
- It should recognize case mix differences in the patient population being treated within the practice.
- It should allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
- It should allow for additional payments for achieving measurable and continuous quality improvements.
"The Patient-Centered Medical Home model - described more fully in materials from the Patient-Centered Primary Care Collaborative, and TransforMED, an affiliate of the American Academy of Family Physicians - relies on a shift in physician compensation from a fee-for-service focus to a patient management focus; from an episodic focus to comprehensive, relationship-based care. It’s been implemented in over 100 pilots around the country. Denmark learned about the model here in the U.S. decades ago and have implemented it fully across the country’s health care system, shuttering most of the acute care hospitals in the country in the process. Pilots in the U.S. include Geisinger’s, which Grundy says has been remarkably successful, yielding an ROI of over 250%, including a 12% reduction in ER utilization, a 20% reduction in hospitalization, ans a 48% reduction in rehospitalization.I agree completely and recommend that you check out the entire interview. We are moving into a new paradigm in the art of medicine. It includes a technologically advanced, patient centered approach that will transform the way we care for each other.
Technology is an important part of these efforts and savings. Even given the potential high cost of technological solutions and Health 2.0 tools, the costs pale in comparison to the $1 million-a-bed cost of hospital construction, let alone hospital staffing and other operating costs."
...
"Meaningful" Progress Toward Electronic Health Information Exchange
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).
Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.
The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.
As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.
The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.
The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”
ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.
CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.
By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.
The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.
Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.
What’s next?
As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for
Medicare and Medicaid incentives.
In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted at healthit.hhs.gov/meaningfuluse.)
Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.
To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.
There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.
I look forward to providing periodic updates, and to continued interactions with all the communities that have so much to gain from this profound transformation.
Sincerely,
David Blumenthal, M.D., M.P.P. National Coordinator for Health Information Technology U.S. Department of Health & Human Services
This letter is part of a series of ongoing updates from the National Coordinator for Health Information Technology. The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).
Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.
The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.
As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.
The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.
The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”
ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.
CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.
By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.
The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.
Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.
What’s next?
As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for
Medicare and Medicaid incentives.
In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted at healthit.hhs.gov/meaningfuluse.)
Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.
To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.
There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.
I look forward to providing periodic updates, and to continued interactions with all the communities that have so much to gain from this profound transformation.
Sincerely,
David Blumenthal, M.D., M.P.P. National Coordinator for Health Information Technology U.S. Department of Health & Human Services
This letter is part of a series of ongoing updates from the National Coordinator for Health Information Technology. The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
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