FCW Insider: A glimpse into the mind of the new CTO

Speaking at a Virginia IT conference in fall 2006, Aneesh Chopra made the case that technology experts could learn a thing or two from heart surgeons in India. He also explained how he thought the best ideas for health IT could come from the practitioners and not from the policy-makers.

Now that Obama has picked Chopra to serve as his chief technology officers, those tidbits, which I reported on FCW.com, seem worth revisiting. Unfortunately, the articles are not available online at the moment, but I’ve dug them out of the archives and pasted them below.

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Virginia's Chopra: Efficiencies won't go far enough
The debate must shift from how health care and other services will be financed to how much they should really cost, said Virginia's secretary of technology.

ROANOKE, Va. -- Virginia's new administration will not be satisfied with simply improving the efficiency of commonwealth agencies, said Technology Secretary Aneesh Chopra.

Virginia officials are rightfully proud of their track record, having reduced the cost of government operations by as much as 15 percent during the last two years of Gov. Mark Warner's term, said Chopra, who was appointed by Gov. Tim Kaine, but such savings do little to improve the quality of life for Virginians living below the poverty line.

To make health care and other core services more readily available to people in need, management efficiencies will never go far enough, he said, speaking Sept. 10 at the Commonwealth of Virginia Innovative Technology Symposium. So the Kaine administration would like to reframe the debate about government services.

Inevitably, when faced with a new program, people ask, "Who is going to pay for it, and how is it going to get funded?" Chopra said. What they really should ask is what could be done to lower the cost of that program, he said.

Consider driver's licenses. It costs the commonwealth about $30 when someone renews a license in person at the Department of Motor Vehicles. If done via the Web, the cost drops to about $4 per transaction. "But what would it take to get that down to a dollar or two?" Chopra asked.

He began thinking about these issues when he went to India as part of a Virginia delegation Warner sent.

During the group’s travels, they visited a hospital dedicated to heart care. More than 6,000 patients have open heart surgery at the hospital each year, with surgeons performing an average of 14 a day at a cost of $1,500 each. In contrast, the average doctor in the United States performs at most four a day, at a cost of $35,000 or more, Chopra said. Yet the doctors in India do not make dramatically less money than their U.S. counterparts, he said.

The hospital has managed this by structuring the work so that the heart surgeon, whose services are most costly, is needed in the operating room only during the most critical phases of surgery, which amounts to about 15 minutes. Other medical professionals handle the rest of the procedure.

India has made similar progress with health insurance and telecommunications, Chopra said, making these services affordable even to the poor. That is the kind of thinking needed in Virginia, he said. Instead, "we seem to live our lives thinking about 5, 10 or maybe 15 percent improvements in budget savings," he said.

Electronic medical records are another example of where the debate must change. EMRs have the potential to improve care for everyone, but such systems can cost $30,000. Many people are wondering how physicians will pay for that, Chopra said, when they really should be asking how to lower that price to $1,000.

Technology can help, but it is not the solution. Instead, "it is the passion and the will of the people to think creatively," he said. The commonwealth and private industry must be innovative, not only efficient. That is how the commonwealth must approach health care, transportation and other needs.

"If we are going to truly meet those needs, we cannot assume the current cost structure for each of those services," Chopra said. Given the limited revenue structure, "we have no choice."

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Virginia takes grass-roots approach to health IT
The governor's office wants to fund projects that reflect the needs of individual communities across the commonwealth.

Virginia's secretary of technology says the adoption of electronic health records is a high priority for the commonwealth, but he is looking for ideas to come from local communities, not the governor's office.

The state legislature has provided $1.5 million in grant money to drive the development of EHR systems. But rather than dictate the types of projects that will be funded, the commonwealth is asking communities what makes sense for them, said Secretary Aneesh Chopra.

Offering the grants as seed money, Chopra wants to see what ideas take root. He calls this grass-roots approach, "Let a thousands flowers bloom." This approach makes sense because different regions of the commonwealth have specific needs that do not necessarily apply to other regions, Chopra said.

For example, in some rural areas, the biggest concern is extending high-speed connectivity to doctors' offices. In the more populous Hampton Roads area, where the military has a large presence, connectivity is not the problem. The problem there is creating a link between the systems in the military facilities and those used by civilian health care providers. Otherwise, military personnel going to a civilian doctor must have their records printed out or burned on a compact disc.

As might be expected, industry vendors have lots of ideas for how the commonwealth could use EHRs and are eager to be heard. But vendors are not allowed to make their pitch to commonwealth officials, Chopra said. Instead, they must sell their ideas to communities. Virginia's EHR initiative will work only if the communities buy in to the concept at the beginning. That is why the governor's office is steering clear of a top-down approach.

"We have a political opportunity to convince communities all around the commonwealth to believe in the promise of health IT," Chopra said. "We want to encourage them to tell us why this is relevant” to their communities.

The commonwealth has assembled a panel of national experts to review the proposals, which are due Sept. 15. The approval process has three phases. The panel first will evaluate the business case for each proposal and measure how well it meets the need that has been identified. Proposals approved by the panel will then be screened for any privacy and security concerns.

Finally, proposals that make it through the first two phases will be ranked in order of merit. If the commonwealth ends up with a strong enough batch of proposals, the governor could go back to the legislature and make a case for more money, Chopra said.