transformation that india itself is undergoing is an important part of this. in the years after independence, india consolidated its democratic framework based on political and cultural pluralism, respect for fundamental freedom, the rule of law and the institutional checks and balances of the free media and independent judiciary, which promotes and perfect participatory governance. this itself was an enormous achievement in a developing country, characterized by great diversity and facing huge challenges of mass poverty and social development. however, our economic achievements were more modest

and there was growing realization that the late 80s that we needed to fundamentally reorient her economic policies, which were focused on self-reliance. the reforms of 1991 radically changed the paradigm of india's economic policies, deregulating the economy internally and liberalizing it externally. the reforms are gradual as the political and social consensus was a democratic imperative. the economy has now taken off and was averaging a growth of 9% for four years before the global economic crisis. while growth tipped during 2008 to 6.7%, it has now rebounded

and is project it to be 8.5% this year and 9% in 2011. india's growth in the first half of this fiscal year from april to september 2010 has been higher than it at 8.9%. our key national priority in the years ahead is to sustain growth of 8% to 10% and to ensure it that this group isn't to say that benefits both sections of our people. sustained high growth will propel the indian economy into one of the three largest economies globally in the coming years. moreover, as india's growth is

based largely on expansion of domestic demand and domestic investments, the indian economy would be an anchor at economic momentum and stability in the global economy. these changes have also altered the way india interacts with the world and the transformation in our engagement with the united states is part of this process. we see the united states as a valuable partner in meeting our development aspirations, and building peace and security in our neighborhood and the wider asian region and in addressing shared global challenges. our cooperation has become more

expensive, our dialogue more candid and wide-ranging. the canvas is fast, encompassing growing trade and economic ties, political and security consultations, cooperation in counterterrorism and defense and joint endeavors in the areas of energy, including nuclear energy and clean energy and initiatives for promoting development issues, such as agriculture, education and health. while asia is transforming rapidly as it surges towards economic prosperity, there are new questions about coexistence, cooperation and competition across the asian region and how these play out will have

far-reaching implications be for global peace and security. situated in the heart of asia, where east central and west asia needs, india has a vital stake in security, stability and prosperity in asia. this is something that we share with the united states and we have agreed to work together to promote an open, balanced and inclusive architecture of cooperation in the asia-pacific region. looking closer to our neighborhood, we have shared a vital interests in stability in afghanistan and in reversal of the tide of islamic extremism,

which threatens not only the security of afghanistan, but also peace and security in the broader region around afghanistan. we have agreed to work together to intensify consultations, coordination and cooperation with regard to afghanistan. and what is new is we will also be looking at development projects, which we can undertake jointly in the areas of agriculture, women's empowerment and capacity building. india itself has committed $1.4 billion in development assistance to afghanistan and our assistance has helped to build infrastructure in

afghanistan, whether it is electricity, transmission lines or hospitals or schools. it is hoped to build more grassroots projects at the local level, which return on the basis of local priorities in afghanistan and it is hoped in capacity building. we offer a very large number of scholarships and training flights to afghanistan, including 300 agriculture because agriculture will be the key to turning around the prospects of the afghan economy and providing people there with viable alternatives to some of the more dubious economic act devotees, which currently are in many areas the means versus of national income.

we've also provided duty-free access to afghan goods. in the indian market is one of the largest markets for afghan agricultural products, whether it be dried fruits from afghanistan or if the melons or watermelons from afghanistan, the indian market provides the ability for afghanistan to productively export its produce. of course, we would be able to intensify what we could import if there was suitable land traffic to afghanistan. but the recent agreement, which was signed between afghanistan and pakistan on trade and transit does not include transit

facilities for india. so when the long run, if we are looking at how we can stabilize this region and provide the kind of linkages and comic dignities, which will enable it to emerge as a stable unit, i think this would be a very important element that we would need to address and we hope that we can work together on these issues in the future. of course we have agreed on very major initiatives during the president's visit. two of these were touched upon by mr. holtz. one is in the whole area of liberalization of the u.s. export control framework as it applies to india. maybe i should choose the word

of liberalization, i should use the word realignment in some sense of the export control framework. but this is a significant step forward and carried to its logical conclusion the initiative of the civil nuclear agreement between india and the united states. because that had dealt with the issue, which had constrained the capacity of the two countries to realize the full potential of their relationship. this initiative will enable much stronger cooperation between india and the united states in the whole field of tool use technologies. and this could emerge as a very important area of cooperation in the future. already today, the united states is the single largest source of tech knowledge he collaboration

for indian companies. as indian companies expand, as they modernize, as they looked towards a global role, i think this aspect of the relationship will acquire increasing importance and new momentum facilitated by the framework, which has now been agreed upon. it has been broadly welcomed across the political spectrum in india. i think the other major area, where we have agreed to cooperate is in the field of counterterrorism. this is a shared challenge. and as the attack yesterday showed the very large challenge we had the federalist attack in

dubai, which, you know, which is something that greatly affect good the public discourse on the issue because it took terrorism -- the challenge of terrorism to an entirely new dimension. and we were appreciative of the cooperation that we had received from the united states in investigating the mumbai terrorist attacks and following dubai, counterterrorism intensify. we were able to establish a new basis of trust and confidence, which has enabled us to intensify intelligence and information sharing into focus on capacity building and sharing of experiences.

during the visit of president obama, we have agreed to have a new dialogue on homeland security. and this will focus on maritime security, more security and so on, including areas such as mega city policing, which would be important for india as it moves ahead in creating the capacity to deal with the gravity of the challenge that we face. as the u.s. is also a federal country, with the same kind of framework -- well not the same, but similar framework, where you have to deal with the powers which are with the federal government and the powers. we have a similar framework in

india and therefore as we move ahead, i think the u.s. experience in dealing with these issues will be very relevant and helpful to s. in creating the capacities in dealing with this challenge in the future. in the realm of security, we have also agreed to work together on efforts towards non-proliferation. indeed, india is situated in what i would call an arc of nuclear proliferation. because if you see the region, whether it was not korea or pakistan or the earlier effort, which was aborted in libya, i mean, you will see that this region has been at the center of clandestine proliferation and much of it has radiated outward from our neighborhood.

we have set up a new center of nuclear excellence for global partnerships. and we will also be the united states in this field. beyond proliferation, we have a shared vision of a world without nuclear weapons. for india, this has been an article of faith. we have always believed that the world would be safer if there were no nuclear weapons, even as we have also held that as long as there are nuclear weapon and the world, including in our neighborhood, then each country, including india, would have to take the requisites for its own security. but of course, we have supported

the non-proliferation framework, even though we've been outside the non-proliferation treaty itself. and we have never exported nuclear know-how or technology to any country. we have exported civilian technologies of the safeguards. and i was in recognition of india's impeccable record in this field, that we were able to build on this to have an agreement for cooperation. so this is another area where we worked together. and in the field of security, we also look at the broader picture, where both countries share an interest in ensuring the safety of and access to what is called the global commons, the maritime -- maritime zones

are leaps of commerce and trade, space, cyberspace. these are some of the areas where we really explore these to involve rules of the road and confidence building measures and make global level, which will provide for the stability of these important pathways, which have become increasingly relevant for trade and commerce in the modern day world. in the economic field, the trade and economic relationship between india and the united states has grown, driven by the momentum in the indian economy and the increasing -- i would say, the increasing

complementarity is between our two economies. i think this is an important fact here that needs to be understood, that the indian economy has followed a model, which is different to that of other economies in asia because it has not been an export model. india's levels of trade are modest, but growing rapidly, trade with the united states is broadly balanced in both directions. indeed, between 2004 and 2008, overall and yet u.s. trade in goods doubled, but u.s. exports traveled during this period. and this was almost the fastest growing export region for the united states. in the services field, which

again i think is perhaps not that well known. trade is broadly balanced. for the last year for which we have results, which is 2008, india exported $10.2 billion worth of services to the united states. and the united states exported -- sorry, the united states exported $10 million worth of services to india and india exported $12 billion worth of services to the united states. so roughly 22 billion in terms of trade and services are broadly balanced. and again, this is growing in both directions. the u.s. exports financial services, consultant services, management services to india. india expert software and i.t. services largely to the united states. and of course in the field of

investment, and again we are seeing that the relationship has become an increasingly two-way relationship. initially, u.s. fdi into india was one of the largest and it still continues to be one of the largest sources of direct investment in india and more so a portfolio investment because that is rebounded this year and we've seen an increase in capital source to our stock market. what is new in recent years is that indian investments into the united states has increased considerably and in some years has tended to be more than u.s. fdi into india. indeed, according to mr. hormats, it is the second

fastest growing fdi into the united states. between -- according to a study which was done for the federation of chambers of commerce and industry, indian direct investment into the united states has been between 2004 and 2009 has been in the region of $25 billion over $5.5 billion in the greenfield ventures and $20 billion in mergers and acquisitions. now, this latter figure of $20 billion of mergers and acquisitions doesn't show in u.s. did it because that reflects the greenfield investment. but it shows that there is very significant investment for india, coming into the united states. and this is across a very diverse range of areas, including manufacturing, such as

pharmaceuticals, automotive, and including information technology. so it's across a very biotechnology. is across a very broad range of site varies. and it is hoping to provide shared prosperity and to stimulate employment in the united states. and i think that is the important thing about the india u.s. relationship, that it is not exposing mutual vulnerabilities, but that it is building towards shared prosperity in both countries. and this aspect of the relationship will become increasingly important as the indian economy grows, as there is a larger market and a bigger

middle class with purchasing power. i think india will be one of the big growth markets for the future. and u.s. companies, looking to position themselves in the global economy would need to factor india into the global strategies if they are to make a significant impact. now, i think for india the challenge has been to broaden its basis the growth. because initially it's been very much led by services, but for a country with the population as large as india, we need to also build the manufacturing sector and agricultural sector. we can't have an economy which balances on one leg because it will suddenly not be sufficient for the challenges that we face. and in this process of

diversifying the economy, and building strength in manufacturing as well as in agriculture, the u.s. can be a very valuable partner. in recent years, we've seen that indian manufacturing and indian industry has restructured after facing initial difficulties when we opened up as some of our companies wef what had been done. because we said, you know, you're forcing us to run before we learn to walk because there was a shelter of the economy. but the net result has been that they have been forced to restructure, to face the global competition. and today in these areas, whether it is automobiles, whether it is generics in the pharmaceutical field or it isn't

heavy industries such as steel, cement, indian industry is increasingly gaining momentum. it has modernized. it is cost effective and it is becoming innovative. you know, initially the indian model was really to just buy take elegy from outside and then they would continue to use that technology for 40 years. you know that we were building the ambassador in the 50th. and in the 80s, we were still building the same car. now, it's a good car and i have no objection to it. it has filled a whole photo album of egregious things, who is seen india through the lens of the window as an ambassador, but obviously this was a symbol of the fact that the indian economy with a seller's economy,

not a buyer's economy. and this has changed. and with increasing competition is come the incentive to change. and you're seeing that india has become a global hub for low cost high tech manufacturing, you know, for areas such as automobiles for the nano car is probably the cheapest car in the world and has led to more than 30 people in car areas, which we accomplished at 16 the cost of similar munitions elsewhere. we have shown a new ability to innovate, to meet our circumstances because the challenges that we face in india are enormous. the market is growing, but it's a specific market with low per

capita incomes, where price sensitivity is very high. and this is pushing companies to deliver low-cost high-tech goods, which are appropriate not only for the indian market, but then have global relevance in developing country markets elsewhere. and increasingly, i see that there are indian and u.s. companies who are collaborating in these ventures. that's against an area that we think that the future holds great promise because technology partnerships between indian and u.s. companies could drive competitiveness and create markets for both countries and not only within india and the united states, but globally.

this has been an important element in our economic relationship, that is that it has been knowledge and technology intention is. and it has been a symbiotic relationship, where we have not been competitors, but we've been complementary. and i think that this is an element, which will increase in the future if we are able to build on the synergies which are so apparent in our economy is. and of course in agriculture, we need to have the next leap in agriculture productivity because the green revolution has plateaued. and while a large number of indians continue to reside in cultural areas, the share of agriculture and the tdp in india has been coming down.

it's now in the region at 17 or 18%. but the share of the population is more than 60%. so how do we trigger this next leap in agriculture productivity? and i would come from really assimilating agribusinesses, by putting in place the capacities for full processing, logistics and building forward and backward linkages between the agriculture and urban economies. now, if you look at which countries, you know, helped us with the first green revolution, it was the united states. the high yielding varieties of wheat fields, we see is introduced by duck or norman helped to change the face of indian agriculture and enable us

to gain some sufficiency. we hope that through collaborative efforts, we can create a dynamic for this next leap in agricultural productivity. and finally, if you look at economic challenges, then infrastructure is a key challenge. it's well below where we require and it's estimated to shave off almost 1%, if not more of gdp growth because of the constraints we face today. it is estimated that india would need about a trillion dollars in investments in infrastructure over the next five years. during the current five-year time period, $500 billion of investment has been projected as a requirement. and we have already, and the

first more than two years of the plan, received investment of about $230 billion, about 70% has come from the public site dirt and 30% from the public dirt. as we move ahead, we would like to see that if we could increase the share of private sector investment in infrastructure, but even sustaining a 30% investment would be important. and you see that this is a shift which is happening in sectors such as power, where there was no private or investment in the past because of difficulties. we are getting almost 50% of your investment in the capacities which are currently under execution. so the current addition to the powers that are, almost 50% of

investment is coming from the dirt and that is the indian air. so we would hope that there would be greater participation by u.s. companies and the opportunities afforded by the expansion of infrastructure in india in the years to come, whether it be in airports, railways, energy or roads. in fact, u.s. businesses have not been on active in the infrastructure there. and this would be really a long-term opportunity, which would help to provide a stimulus, not only to growth in india, but also to growth in the united states. indeed at the g20 meeting, prime minister mentioned that, you know, investment of capital is unable on term capital on

building infrastructure in developing countries could be a useful outlet for his sublists capital and the developing countries, which is set to present go in and pulitzer and capital flows into developing countries that could be channelized into long-term investments in infrastructure, which would have benefits for both sides. in the field of development, we have agreed to explore opportunities in education, in health and in agriculture. and again, these are key priorities for india. and we see the u.s. as a valuable partner in meeting our development aspirations in the steel. the opening up of education to

education service providers, the compulsion to grow the infrastructure for higher education, school education and vocational training has led to a decision by the indian government to increase outlays on education from the current 9% to almost 19%. that's the kind of expansion that will go up a new range of opportunities. indeed, i see education as the next great area for growth in u.s. ties and connections. i think an important element of the dialogue during president obama's visit was to focus on what india in the u.s. can do, not only bilaterally, but also

globally. in this connection, we very much welcomed the support extended by the u.s. president for india's permanent membership in the reformed u.n. security council because while there is a growing realization that global challenges today require your the cooperation of emerging economies to the effect to, then there is a sense in india that these countries have to be given a greater say in shaping the outcomes, whose decisions -- and shaping the decisions to sell they are expected to implement. and so, this has been very broadly welcomed in india. and of course, we note that it is something which will emerge only on the basis of creating the appropriate consensus in the united states for change, but we are encouraged by the fact that

there is growing support within the united states. that within the united nations, for change in the existing structures to better reflect contemporary realities. we have also agreed to see what india and the united states can do together in areas such as agriculture, and africa, in afghanistan. and this is a new element in the partnership that we are seeking to build. so as we go forward, i think india's own economic growth, its national priorities which focus on creating an environment, which facilitates our sustaining this economic momentum, our development aspirations, our shared values the united states, are increasingly convergent

issues will provide a substantial basis for carrying a strategic ridership forward in this 21st century. thank you. [applause] >> thank you, ambassador. you never fail to amaze us with the breath of your knowledge as a very comprehensive look at the relationship. i apologize on behalf of dr. holmes, for him in matter driver porting of june board meeting today and we have literally thousand of our biggest donors in town. so he got pulled away with an emergency now, the port needs you now. that keeps the lights on around here so we had to head out. on his behalf of the heritage foundation, we thank you very much. i hope to see you back again here soon. thank you. [applause] >> for those of you who don'tise

summers. this is an hour 15 minutes. [inaudible conversations] [inaudible conversations] >> good morning, everyone.

my date is david blumenthal, national coordination at the halted human services. want to welcome everyone from the public and the press as well as our distinguished panelists here today for a very important announcement about a new report on health information technology. but first, i would like to introduce an disagree pillage and pressure to introduce my boss, the secretary of health and human services, kathleen sebelius. throughout a unique and challenging and exciting time in the history of our health care system, secretary sebelius has provided steady rise and creative leadership on a wide range of issues that come before her, but most exceptionally on health care reform, reforming our health care system and also on an issue that my group, my agency is most concerned with a knot of information technology.

as the insurance commissioner and governor of kansas before coming here, she learned how to reach and guide consensus on highly contentious and important issues in the issues that we will be dealing with in the area of health information tech knowledge he certainly fit that description. so it is a great privilege to have her at the helm of the shift during these exciting times. director kathleen sebelius. [applause] >> well, good morning, everybody. and thank you, david, not only for your nice introduction, but for your incredible leadership of this important project. i just came from a discussion with the ceos of the business roundtable and i want to tell everyone on this panel that a

new report of realizing the full potential of health information technology is near and dear to their hearts. the first question i got asked was, how does this relate to the momentum underway for electronic health records and happily make sure that's on track as we implement the affordable care act. so this is being watched carefully across the country. i am glad that all of you are joining us today to talk about this important report, realizing the full potential of health information tech knowledge he ip cast. the president's council of advisors on science and technology. what you recognize the leaders who are here with us today, who deserve a lot of credit for pushing health i.t. to the top of the national agenda, where it needs to be. dr. eric lander is here,

cochair. and dr. christina cassel, who led the working group on health information tech knowledge he. it is nice to see chris again. she and i worked together in the 90s on various health issues. and i've kept track of her, but i don't get to see her play often enough. dr. david blumenthal, who is our brilliant entire list national coordinator for health information technology. and dr. larry summers who has helped guide our economy during some of the most difficult times in the nations history. and i also want to recognize at&t mobile health and kaiserñ permanente were also joining us today. these organizations have been real health i.t. partners and pioneers. so the report that pcast is releasing today helps reduce

paperwork, protect privacy and improve the quality of care. in industry after industry, we've seen a power of information technology bring down cost and improve customer experience. now, join me for just a moment and imagine going back to the days where you walked into a grocery store and the cashier was looking at handwritten price tags and punchy nose and were waiting for a bank to open ever? time you needed cash or pay in every bill a check. i don't think most americans would ever accept that. health care shouldn't be any different. and in fact, what we've seen in hospitals and doctors offices across the country is that when electronic health records are well designed and implemented correctly, they are a powerful force for reducing errors, low whirring cost and increasing both provider and patient satisfaction.

and i've had the opportunity in this role as secretary to visit with health care providers across the country. and they still haven't met a single doctor who says i really want to go back to those days where you had those great paper files. you know, that was really the way liked to practice medicine. and yet, when this administration came into office two years ago, just to intend that there's an one in 10 hospitals even use the basic electronic health record system. and that is because even with the benefits of the h.r.'s, there is a very daunting obstacles. it takes time to learn a new type allergy, especially if you're a talk or in a small part is without a health i.t. staff. there is a challenge of being able to share information securely with other providers if they have a different system. and then there's the fact that the systems can be expensive.

even if they pass in the long run, there is an upfront cost. and that's why as part of the recovery act, the president made a commitment to make an historic investment to eliminate some of those barriers. we're creating regional extension centers modeled on the old agriculture extension centers. the smaller providers and small hospitals can get hands-on technical support, setting up and running their own i.t. systems. ..8 y4çqyq;]çyç5

personal health information has been our top priority and will continue to be. since we began taking these steps, we have seen a new momentum behind the electronic health record movement. in the past, some providers have expressed skepticism about the standards they would have to meet in order to earn the incentive payments, but in the last few months leading doctor and hospital groups have come out supporting the standards that have been announced and we want to keep the momentum going. when electronic health records are widely adopted, doctors will have better information and more time to focus on patients. patients will have more control over their own health data. employers will have a healthier more productive work force and a

stronger bottomline. and as the report we are releasing today also shows, there will be more jobs for americans and one of the key new industries of the future, the technology itself information. so we are already making great progress, but we've got a long way to go and i want to now ask to come to the podium larry summers, is the chairman of the president's economic council to talk more about the report. dr. summers. [applause] >> thank you. thank you, madame secretary, an? thank you for your ex?traordiny leadership that is the reasonñ? large part why all americans are going to have health care going forward. ? are very fortunate to haveñ??

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first, this is good??ñ? jobs and macroeconomic policy.? if you think about economic??? situation, we have got excess? capacity in? many areas.???? there are too many houses that? have? already been built.??? capacity utilization? in???? factories.??ñ??ñ??? consumers are over latter, over? borrowed, relative to their??? assets.ñ????

where can the spending power?? ?at we need to accelerate recover and come from????ñ?? part of the story is correct?ñ? government actions and that is? why the agreement reached a??? couple days ago on tax policy i? so profoundly? important.??? part of the answer lies in the? international sector and???? exports.?????? that's why the president's free trade agreement with korea is s? profoundly important and much else we are doing to promote?? exports.ñ???ñ????ñ? and part is an investment but at ?e moment when there is so muc? excess capacity we have to??? define the categories of???? investment a little bit more?? carefully.÷? you know, for one reason or??? another our family has a completed more pcs ? ???????

employed resources, which can be put to work providing jobs that? are important in the chart run and providing capacities that are profoundly important in the long-run. long run. that is why health information technology was so crucial part of the recovery act, and this is probably one of the largest efforts government has ever undertaken to spur investment in a particular crucial subsection. second, this is the essential

health policy. i would suggest to you this principle. information technology in the american health care system should be as pervasive in the treatment of patients as it is in the billing of patients. i can assure you that information technology plays a larger role in 20% of doctors offices involved in billing and i can assure you that it is far larger than 10% of hospitals use information technology in assuring that they are compensated. there is no good reason why the average 7-eleven uses more information technology than the average doctors office. it is wrong and it is costly. it is costly at a time when one in 20 prescriptions involve an

error. it is wrong at a time when tests are done and done again and done again, because it is not possible to transmit the results from one doctor's office to another doctor's office, and it is wrong when the average? medicare patient receives care? from seven different positions in four different? organizatios in the average year. this is not a problem that will fix itself. the essence of this problem involves networks. you know the first person who got a fax machine really could do very little with it. the second person who got a fax machine actually could do more. they could fax to the prayers -- first-person but unless they

were married to a show that wasn't exciting when there were two fax machines. when the technology spread, the benefits increased far more than proportionally, because networks were central. so it also is with information, health information technology and that is why government needs to give this a big push. that is why the private sector needs to collaborate. that is why at the center of anything that involves connectivity, is the capacity for connections and that is why the issues of open standards that are stressed in this report are so profoundly important. this is good for the economy. this is essential for the health care system. there is a third reason why this is very important.

it is essential for people and can change their lives. actually it can save their lives as i was driving over here, and this is not in my written text, i was reminded that just about 25 years ago, i had been in the hospital for some time with something fairly serious, and thought that i was leaving at the end of the afternoon. and, at 3:30 someone arrives to tell me that actually i wasn't leaving, because my blood count had deteriorated very sharply and they were going to need to a value with the situation and it was likely a need for several transfusions and this was a very serious problem. as you can imagine, it was a

relatively traumatic our until they arrived somewhat sheepishly at 4:30 with a combination of good news and bad news. the good news was that i was okay. the bad news was that they were a little embarrassed that they have had a certain confusion in reading a handwritten record in distinguishing between the words summers and the words symonds. all that meant for me was an hour as dramatic as any as i have ever spent. one reads that for thousands of other people the consequences? ç?eç? vastly re--- more serious? thanç? that.ç?ç?ç?ç?ç?z?s?z?z? don't we deserve to do better?ç? let's z?never forget as we talk? about the economics, as we talk? about the efficiencies, as we talkç? about the issues facing

different providers that doingç? çisç?ç? faster and better is a? about life and death for thousands of our fellow citizens. thank you very much. [applause] >> maybe i should give our next guest the courtesy of an introduction. professor professor eric lander from m.i.t. and a colleague of mine from the boston community and a really distinguished leader in many many respects but here especially in the area of biomedicine but here today as the cochair of the presidents council of science and technology. welcome, eric. thank you for being here.

>> thank you very much. i am here is the cochair of the presidents council advisers onx science and technology.xwxx i would like to specifically acknowledge two of my colleagues here. christine cassel who is sitting here and craig mundy who is sitting there, whoably cochaired the working group that studied this problem over about nine months. so i want to thank you vote for your extraordinary service here. .. zzçzñzzçç

increasing quality and decreasing costs. there's a huge potential and chris was a more about it to use of information technology, to integrate for example patient data so you can see a big picture of the patients to avoid errors, detect changes in records by comparing over time, provide decision support with the latest information to doctors. but also to larger levels for the overall health care systems to make it a learning system, one that's able to determine side effects earlier or identify what treatments are especially effective for subset of patients, and then also to be able to drive down costs to more efficient business process these. that information technology has indeed transformed so many segments of our economy. portable phones and work processors, things we did before and less efficient ways, and things we never did before.

searching all the world's information, for example, or social networking on a scaleññññ never before imaginable.ññtt byetññ contrast, health informñ technology has lagged behindmç tremendously. as has been diluted to most physicians don't have access to really meaningful, digital, electronic medical records and those who do, well it's often a rather cumbersome, the sort of thing they never tolerate in a word processor for its simple, it doesn't let them into great things, and so has again has been noted, the american recovery and reinvestment act provided a historic investment in incentive payments to physicians and hospitals to acquire and make meaningful use of health information technology. the office of the national health information technology led by david blumenthal and cms have developed meaningful use

regulations and starting in this coming year these incentive payments will begin to transform health information technology. against this background, the president asked his council of advisers about a year ago to look at whether we thought there were any additional components that were needed to fulfill the extraordinary promise. we've identified one majorzç issue: the data that exists in the health information systems that we have today and in the systems that will be acquired by physicians and hospitals with the funding under the era of legislation really contains it's the cut in the incompatible proprietary systems where it's free hard to integrate data across the systems. that's a problem for the patient because the patient can't obtain a coherent picture of all of his or her information. it's a problem for the patients

health care providers. in addition, it's a problem economically because the third party innovator who is the heart of i.t. innovation, the people who compete to write the better word processors and search engines, when they come from the market that is fragmented into hundreds of separateç incompatible pieces, theçç incentive to create a truly innovative tools, the economic incentives, the ability to read the rewards for innovation are so much blunted. now, our question was could this be fundamentally solved in a way that did not require everybody to start over? one tempting solution is just get rid of everything and start over. it was a going an assumption that that was not an acceptable solution nor would it be in mexico solution to say the federal government should write the system for everybody. there's a lot of good reasons i is a terrible idea. and could it be done in a way that protect patients' privacy?

that's a very important thing and central to our discussions along the way. so through the working groupññ? çaired by chris and craigçzç assembled experts from withinñ?? the council and from without an? the short answer to thoseñññ questions was yes.ñññ??ññ it turned out the key to really being able to do this is to hav? the? capability of universalñ? ñchange language.ñññ ?u don't have to go to ensure? universal systems, but if there? is a universal extremely kitchen to any system could write andñ? out of which any system could? read, we could gain most ofñ?? those benefits as technicallyñ? possible to do it it turns out? yes.ñ? it ñturns out that there are t? same sort of technical??? approaches that make it possibl for many different browsers,ñ? proprietary browsers to browse websites in their own wayñññ? because there's universal?ññ exchange language that makes it possible to understand what those elements are and bring them back together.

it is a solution that works elsewhere. you need to have a certain type of approach we referred to as medved data tagging approach. it will be geeky but on the road there has to be geeky stop to make it work. there has to be in infrastructure for la and authorized users and will be authorized users access to the data tags in an appropriately. what it doesn't require, number one, it does not require a central national database of everybody's health information, not a good idea, doesn't require it. what it doesn't require is national patient identify years to make such a system work, not necessary, not even a good idea. but it doesn't require it is for everyone to discard their insisting systems, but rather, to be able to build a layer on top of the systems to translate in and out and over time as the systems are updated and revised, the providers of those systems

can build into rather than on top of these types of standards. what are the kind of teachers? well, it lets privacy be protected and vastly better ways. it can be protected that would avert granular level you want. you could have privacy not just around an entire record but around a particular item within a record. that's extremely important. and you would be able also to make choices about your privacy early and have them be persistent. so it provides a greater flexibility in architecture for? privacy to be indicted withinñ?? healthñ? care systems.ñ? and what it does is it canñ?ñ? unleash creativity of the marke? and market innovation.ñ? now does require something.? to get this done the federal government does have a role,ñ? ñ?use larry summers said, this? is one of the greatñ? collaborations that america is so good at. the vast majority of the business be done in the private-sector.ç?ñ? but if you have a commonñ?

universal? exchange language it does require a coordination, and that is a classic role for theñ? federal government is to be able to bring together industries to? develop such universal exchange language and open standards and? a way that's available to all. and to be able to invent this notion within the meaningful us? regulations.ñ? this is the sort of thing theñ? federal government can do thatñ? is catalytic it is not enormously expensive to do and it benefits all.ñ? everyone would like to have such a thing that no market incumbent is in a position to promulgate such a thing but a federal government is in a position toñ? bring people together to develop such a thing and then read the? benefits that come from it in performance and in competition. so, in closing, and many, manyñ? different ways it is clear this? administration is focused onñ? improving health care.ñ?ñ? the notion of better quality an?

lower cost is at the heart ofñ?? many of those historicñ? legislation, pieces ofññ?ñ?? legislation that have passedñ?ñ already.ñ? it's a part for the president's? council advisers are proposingñ? today. i would like to now turn to myñ? colleague, chrisñ? cassel who ia physician and in a position to really talk about what these types of approaches would mean for medicine, for physicians, hospitals and patients. thanks very much. chris. [applause] >> thank you. i want to thank am i pcast colleague david blumenthal with whom we have worked very closely as well. as you can see, the recommendations of this report really to build on the very important ground breaking work that he and his colleagues atñ? onc have done. but i think it's also important? for us to be able to think abou?

how this strategy and vision for health information technology can leapfrog into the future to? provide much better patient care to reduce the kind of errors that larry summers talked about? and to make health care practice much more affordable and muchz?? more efficient.z? let me just outline fife benefits i see from my perspective and that are written in the report as well. the first is real-time access, real-time access to complete patient data and information and support information support from doctors and nurses in their decision making. so if you have all of the information on a given patient across time as well as across multiple providers and multiple organizations it will improve the process of diagnosis,

reducing stakes and save time but it also will enable doctors to analyze data on their whole population of patients they are taking care of and be able to themselves tell how many of the patients with hypertension have their blood pressure under control or how many patients with diabetes have their blood pressure under control or diabetes have blood sugar measurements within their normal range or getting the the necessary screening test. consider the following for example, we have a number of use cases in the report which i urge you to look at. but let's imagine a 70-year-old woman being treated for cancer who travels to a referral center for more specialized treatment. when she gets there all of her records are now instantly available, avoiding a repetition of painful and expensive diagnostic tests. after she is treated, she

truffle's 1200 miles away to stay with her daughter while she recovers. but in her weakened state, she falls and bricks of hip. she goes to the community hospital the emergency room where immediately all of the relevant information is available to the trading staff and drugs that would have been dangerous with her recent history are avoided. when she recovers and returns home, the information from all of the places where she has bee? seen are available right away to her personal physician. how many americans today can be confident that this is a story that would happen if they orz? their parents were in such añ? situation? very few actually.z? our vision is this becomes a reality and this becomes a standard of care for everyone. the second benefit, and approved clinical practice with information technology and integrated into the workflow

minimizes unproductive date entry work. i have to tell you from thez? perspective of a physician, these days is often three cumbersome and costly demanding the time to report called the measures for accountability and payment for services which are very important. a better health care i.t. strategy could help reduce the timing cost and allow the data to be collected in the actual process of patient care not as an add-on piece of work. these days much of the information is produced for insurance purposes but it's not timely enough or complete enough to drive improved care. yet most physicians and nurses are interested in the responses to the accurate evidence of having the quality-of-care measures produced in the process of the patient care rather than as an additional data entry process and being able to interrogate your own nti and ask

questions about certain kinds of drugs, their effect, certain kind of treatment, a certain kind of patient conditions will lead to significant health care improvement. faired benefit, patients, consumers can't become more involved in their care and able to track their health data. access to both the information and multiple interfaces if you want to think about it that way will the kec for the patient to access information from multiple different sources. the participation of the patient in their own health care will substantially improve not only their care, but their confidence which is especially important, particularly in the management of chronic conditions such as heart disease, diabetes and others. consider this case, this use case. a patient who is taking blood thinner strains his calf muscle during a tennis match and cannot

remember which of the over-the-counter medications is safe to take a given that he's taking this blood thinner. so he types the information into his personal health record list, and it gives him the answers to his questions. indeed, it turns out that there are certain paint hills you should take and certain ones you shouldn't take. ki e-mails the physician the next day though because he has a bit painful bruise appearing in his leg. he sends another e-mail to his physician's office where he is connected to the nurse who manages the blood coagulation test. online he makes an appointment to come and he makes an appointment to see the doctor who responds with electronic information about the result of the test and the medications just as he needs to make before he ever even sees the patient fourth benefit, privacy and security can be embedded into the means of exchanging data to

be persistent and accurate. this approach can improve privacy and security and patient control of the data. the very same mechanism for exchanging can be embedded with the necessary security and privacy precautions attached as metadata. so it is inseparable from that data. all computers offer the touches the data will be legally required to respect the privacy? specifications. and fifth and important, health care research will improve both in terms of public health monitoring and testing and clinical trials. real time identify the data will allow much fasterx?z? identification, cd problems with drugs and medical devices allow early awareness of infections, epidemics and other threats to the public health.÷?

this is a benefit to the public? through hhs agencies like the fda and cdc and state public health authorities as well.z? an example of this is the devotee of the kaiser permanent? a we are going to hear from in a moment with their electronic patient records to identify the? problems of cardiac side effects long before the marketplace studies revealed the spirit also, clinical research studies by the nih will be dramatically enhanced and accelerated by the capabilities. extensive sampling to be randomized clinical trials will not always be needed because an accurate information about patients' conditions can sure which particular groups of patients are more likely to benefit for the treatment which could then rapidly accelerate both the use of treatments where appropriate but also not using them when they are not appropriate. so these five areas really are

we to go to improve care and efficiency for over health care system, and that is what our report is aiming for. utter care, more personalized care, more efficient care and more gains in health. these are all part of the?ç?? problem of the 21st century information technology. it is now my pleasure to turn this over to the two representatives of majorç? companies, businesses that have? used and invested in this kind of resource. one in health care delivery and health care delivery systems, bernard, executive since president of health plan hospital operations for the kaiser permanente a is with us today, and one of information and communications. bill archer, president of advanced solutions will also join. i'm going to call one bernard first. [applause]

>> good morning. it's great to be here today to speak on this topic on behalf of kaiser permanente but also on behalf of a personal story. i was thinking as we were talking through this this is about future but is here now. let me tell you a story quick. september, 2006, i was having fun and less vigorous the custis sixth loss vegas, not that kind of fun, and in that having a heart episode that landed me in the emergency room at one of the community hospitals in which i suffered a cardiac attack.

i was placed in an induced coma and told later hospital contacted through a friend traveling with me, kaiser permanente who in a matter of seconds was able to download all of the information they had on me and had to tax to a hospital in las vegas.ñ?ñ?ñ? fortunately the information isñ? readily available and we did have the facts. this vision will even make that? step. ñ?d will transform it to another level. i was brought of the, and then ? was transferred to my hospital in san francisco with kaiser, where i underwent open-heart surgery. i went back to work in januaryñ? of 2007, and as of today, i hav? not been out ill a single day.

but 90% of my care that i get from a qualified cardiologistsñ? or qualified nurse and a couple of other team givers is provide? to me for the kaiser permanente? health connect.ñ?ñ? i have all the information made availableñ? to me to keep me we? informed about what's going on inside of bernard tyson, and i have the connection to my care team to understand what they need to do next to my overall care and in most cases, that is done over health connect. the future that we are speaking about is here today. this past weekend, i went in fo? my lab test as i am preparing to see my doctor on this friday coming up as i like to say at 3: 40, and i went into one of our last facilities about 9:30 onñ? saturday morning, had my blood

drawn and about 12:15, 12:41 blackberry pager went off to give me the message my labñ? results are in it. i got home about 2:00-something and went on line to public my results. everything was looking good with the exception of one particular test that was slightly elevated, still within normal but slightl? elevated. i was able to punch one button to than grass the last nine tests i have taken over the last couple of years to do my own and trend analysis. then i send a note to my care nurse as well as i physician said i will see you next friday but i am curious what might be causing this slight elevation. i got a message back from myñ? nurse that said this is a great result, slight elevation,? nothing to worry about. see you next friday and by the way, we will discuss when you

eat over the holiday season. [laughter]ñ? i think they are getting to know [laughter]w'w'wswswswsvs we believe at kaiser permanente a that what i just described to? you, what is available to 8.7 million members who belong to kaiser permanente should inñ? fact be available to every single person in this country. we believe strongly thatñ? information technology in theñ?? hands of experienced caring physicians and clinical staffñ? makes a difference for ourñ? members and our patients everyñ? day.ñ?ñ? we believe that by having allñ? the information available at an? given time caregivers can makeñ? it more informed decisions about their patient health and the to? help manage their own health more effectively, and by applying the information technology thoughtfully that in efficiencies of tests and treatment redundancies are

unnecessary office visits and costly emergency rooms can be reduced and in some cases eliminated. we achieve better health outcomes as consequence of our extensive investment and information technology. beginning with the kaiser permanente electronic medical record which recall the kaiser permanente health connect. this provides the foundation for our outstanding care. by building on that foundation we are supporting tools and technologies such as care registry's we are able to identify at risk populations and provide care teams with organized consistent per your kristen formation

>> that's our vision, and we know now that we can achieve it with the technology and with the brain power of the wonderful people who work at kaiser permente. they have seen the intersection of technology and research with results not only benefiting members, but also the community at large. our collection of data for very

large patient populations enable us to spot trends in medication effectiveness and care outcomes and studies formally impossible in size and scope. through research assisted by this expensive health data and information technology, we found, for example, that unvaccinated children are 23 times more likely to get whooping cough than children who were vaccinated. extremely obese children have a 40% of reflux disease of the esophagus, and that there is a link between smoking, alzheimer's, and dementia risks. with nearly 4 million members using my health manager, the personal health record available on our website, kp.org, is clear that demand for online health care tools is growing.

our members have 24/7 access to the health information and a communication tool to reach their providers. today, california permente members are on track to send more than 10 million secure e-mails to their physicians through my health manager as well as reveal over 25 million lab results and to make five-plus million appointments online, and that's just with 4.5% of our 8.7 million members currently using our my health manager. these services and overall health portfolio technology tools reduced unnecessary inperson office visits by nearly 26 plgt. 26%, and we reduced emergency room visits by less than 11%.

we are using this tool to better understand and capture data that is allowing us to make better decisions on how the staff can manage our facilities across the united states. a medical record is most effective when it is accessible to both the patients and to their providers. as patients move across geographies, providers, and insurers, port the of their records will be an essential requirement for electronic health records. kaise permente is working on connecting the in addition's emr's beginning with a pilot program to link the largest health record with the largest governmental health record, that of the va. using nhin we share the information of 1,000 of our shared patients proving that

more complete information is possible when shared across different providing organizations. we all agree that we need better health outcomes, and more efficient care nationally. we not only believe that health information technology plays a critical role in achieving better health outcomes. at kaiser permente, rea proving that it actually does. thank you. [applause] >> good morning. i'm pleased to start by saying i don't have anywhere near as dramatic story to begin with as bernard did, but nonetheless, very pleased to be with you this morning, and i want to start by thanking eric and christine and secretary, dr. summers, and

dr. bloomenthal for hosting this great event today. at&t is great to have this chance to collaborate with policymakers on health information technology which we believe holds great potential for improving the u.s. health care system. we believe we have a unique perspective on the promise that information technology holds for improving access to health care in this country. we're large, self-insured employer with more than a million lives under coverage. we are deeply involved in the health information technology and mobile health markets as businesses, and we're also actively engaged with the dosia consortium in developing a personal health record platform for the benefit of our employees. at at&t, we have a firm bleach

that the use of mobile technologies and smart networks can improve the quality of care, reduce costs, and cricket to a -- contribute to a healthier world, and now is the time according to the centers for medicare and medicaid services about $2.5 trillion was spent on health care in the u.s. in 2009 in efficiencies abound, and one of the big problems is a lack of timely access to the critical information that's required to deliver quality care efficiently. ..ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?

believes it is to drive full nationwide deployment of health information technology. improving the functioning of our health care system we believe it is vital to our economic interests and to our continuing ability to competeñ?ñ?ñ? internationally. now, improving care and reducing costs are vital goals for every? business.ñ? for at&t, in 2190 offered healt? care benefits to some ñ?2 million individuals.ñ?ñ? those are employees, retirees and their dependents. so you can tell ensure we haveñ? serious skin and the game from many angles here. you've already committed to

bringing our assets, talent and resources to bear on helping the healthcare industry to getñ bandages or technologies to solve the challenges it faces. now as any health care professional will attest, healthcare is a highly mobile business. medical information needs to follow the patient, searching for it once the patient is in crisis can hinder the quality-of-care, of course, be very expensive. many of rubber healthcare industry solutions are designed to address exactly how this issue. one of the key challenges for a sample of the hull flighty industry faces is allowing for connectivity among existing electronic medical record deployment, thus protecting much of the investment that's already been made in digitizing and storing medical data.ñ?ñ?ñ? at&t health care community on-line helps with that thez?ñ??

wallen health care providersñ?ñ? state and federal governmentñ?ñ? agencies to save time and money? by using the existing i.t. infrastructure and integratingñ? it with new services and applications to enable community wide exchange electronic medical records. we also believe mobile and telehealth solutions offer exciting potential to improve the way health care is delivered. take one example from the technology network uses video conferencing and mobility solutions to improve the quality and speed with which they treat patients wounds, and the results are very impressive. they've reduced hospitalizations by 95%, hilda wounds 50% faster than hospital based wound based centers and cost for the paper's

of to 85%. now in addition to those quick examples, they plan to participate in a series of pilot programs and trials that will test some of our key technologies with patients and providers. examples include medicine bottles that remind the patient to take the pills on schedule. devices that monitor patient part or glucose levels from the comfort of their homes, audio and tdo thinks that can replace the need for in person visits to doctors and more. we believe solutions like the ones we are currently delivering and testing as was mentioned before can be transformative technologies, in fact, similar to the way atoms transformed banking transactions or on line booking of travel requirements. now as further evidence of a

hour commitment, we just announced that dedicated practiced call for health, at&t for health will accelerate delivery of wireless network and cloud based solutions specifically for the health care segment. summing it up, we believe it's vital for health information technology to be widely and rapidly adopted across all segments of the health care sector. we are seeing substantial progress has has been mentioned, but there is much skill to be done, so we are very pleased that pcast focused its efforts on driving health information technology adoption nationwide. we believe the goal is vital to improve health outcomes, drive down health care costs, spur investment and create quality high-tech jobs here at home. improving the nation's health care system is truly a goal of generational importance and one that will help ensure our

country's competitiveness for decades and forward. and we at at&t look at the day when the health informationz?z?? technologies are widely deployed and benefiting all americans. we remain committed to improving the quality-of-care, reducing costs and come to a meeting to a healthier world and we are eager to continue working with the administration of these important issues. thank you for your attention this morning. [applause] >> thank you, mr. archer, mr. tyson for being the private sector perspective to this and taking the time and effort to be here with us today. we know you traveled long distances to be here. i also want to thank our pcast colleagues, eric lander, chris cassel, lander for the contribution and laying out a

very important challenge for us in the department of health and human services. and of course i want to add my thanks to secretary sebelius and larry summers for attending and starting off the discussion today. mountain climbers know the feeling of working hard to get to a summit, only to realize there may be three, four, five summits still to climb. as the mashaal coordinator and center for the services in the department of health and human services, we've been working very hard to implement the high-tech agenda laid out for us by the congress of the united states and the president as a part of the stimulus bill of two goals and nine. we felt we were doing a pretty good job. we thought that we were doing okay.

the pcast folks have landed on the next peak and sent to us in effect congratulations on what you have done, would there is a whole lot more still to do. if you set your vision highly enough, if you work harder, if you are nimble, if you're ambitious, if you're quick and decisive. we welcome that vision. this ad ministration is showing you graphically right now through this particular report the importance assigned to the vice of the nation scientists and technologists, and we share that appreciation. we wish it came with a!! helicopter, but we think that will come, too. now what have we been not to for the last 20 months or so

implement in the high-tech act? we have been working on two of the most important priorities of that legislation. the first to promote the adoption of health information technology especially electronic health records. some of the benefits have been discussed by our panelists already here today. and secondly, to accomplish something that is equally important and that is the meaningful use of electronic health records. it has been really bipartisan support for this agenda of promoting health information technology, a widespread recognition that the capacity of its kind of seemingly miraculous things kiser has already put on the table and chris cassel described in her cases. the congress mandated as first to work on adoption. i think the perception was before you could enter operate

the need to operate, and we need to get data, clinical data into electronic form before we can send it shooting around our health care system in a way that our so powerful has described. by the way, in the process of promoting that adoption, we think the federal government leadership has unleashed an enormous amount of innovation, some of which is described to you by mr. archer but is happening throughout our health care system and our i.t. industry. someone once described to me that the day after the ipad was released his company which produced an electronic record had an ipad based solution to the electronic of record already available. kind of explosion of new thinking, the entry of new firms

don't think would have been possible without the leadership shown in the high-tech act. we have also been committed to obtaining meaningful use. the congress was very clear they didn't want computers to be doorstops or paperweights and the nation's and physicians and nurses. they wanted those technologies to be used for self improvement purposes. and that has been a guiding principal of the center for medicare and medicaid services of the office of the national coordinator in our design of the meaningful use from work. the free-market spot health care goals as the absolute priority. there are a series of them bitterly and held in the regulation creating a meaningful use from work and it has put the patient first in terms of patient involvement with care in terms of the leading providers to provide health solutions

rather than technology solutions in order to support a meaningful use capability, we also enacted a series of supporting regulations. one, to create standards and certification of electronic health records that we have actually begun the process we believe of preparing the way for the kinds of solutions that the pcast report has advocated, universal standards that's promote interoperable the and aníbal communications across electronic of records as well as guaranteeing the functionality of the records that were adopted. and we have created a process to certify electronic health records as capable of meaningful use. over 130 electronic health records and electronic modules have been certified in the last two to three months going basically from the dead stop to

full speed with the provision of information to providers of care about the capabilities of electronic health records on the market. we know though that just providing the technology will not be sufficient, so we have been creating the capability to support willing providers to become meaningful users. there are now 62 regional extension centers covering the entire geography of the united states, which are available to providers able to independently about and meaningful use electronic of records. with the help of those electronic -- with all of those extension centers, we have now enrolled already in the first ten months of their existence, 25,000 primary-care physicians to obtain technical support services on the way toward

adopting and meaningfully using electronic of records. we've created a nationwide program of begin communities, whose purpose is to demonstrate what is possible in a community to do with information technology through improving the outcome of care and the efficiency of care. these are community-based activities, collaborative of providers, insurers, health care organizations, local employers, city and state governments that are working together to demonstrate to the fit and in fact to be deacons for the rest of the nation. there's an estimated shortage of 50,000 health it workers, without whose help all with our efforts to get operating electronic health systems up and running will be for naught. we are now spending $120 million through 84 community colleges,

training 40,000 health information technology professionals, 3,000 enrolled in the first cohort in september. and i visited the first graduating class of one of those programs. virtually all of the graduates have jobs either with providers of care or with vendors of health i.t. services or with local governments. the have been successful demonstrating that high-tech stimulus program can develop opportunities for new jobs that have a future in an expanding electronics sector. we've invested in cutting edge research through for a consortium of research institutions that are working on the technologies of the future that can make interoperable the real, but to make privacy and security more effective that can

make systems and electronic of records more useful. .. don't lose track of the huge benefits of interoperability and don't forget to build in that capacity at every step of the way. and we are going to look and incorporate those recommendations as speedily as we possibly can into our work, using our federal history

committees which have served as admirably after this point, looking at a standard and certification criteria to see how they need to be modified, looking for beautiful use framework can assist with the interoperability -- the interoperability capability. we said in our meaningful use regulation published last july, that the next stage of meaningful use would emphasize health information exchange. so the pcast recommendations could not come at a more timely place in our agenda. i want to say as we go forward that throughout this work our commitment to the privacy and security of health information that remains resolute, it is absolutely essential that we have the trust of the american people to create a viable national, interoperable health information system based on modern electronic.

we have to keep patients and consumers in step of the way. they need to also worried about the risk. the technological opportunity created by pat tagging data, checking how to with preferences for its exchange ability and availability is a very important contribution. it needs to be complemented by a range of policies that provide a complete package of solutions to the privacy and security policy challenges that we face. but we are committed to moving forward with a policy agenda as we move forward with the technology agenda. so to reiterate, we welcome the pcast reporter.

we think it pushes us forward and set new goals for us. it provides exactly the kind of external advice of his major policies, we think, to disappoint successful where they have been successful. and we look forward to working with our pcast colleagues as we move forward. i also want to say that the pcast report will be online for the requests for comment from the financial coordinator by the end of the day today. it will be open to comment -- the invitation for comments will be open in the federal register for 30 days till the middle of january. thank you very much for your attention. hot mark [applause] >> at hursley like to thank david blumenthal and his colleagues at the office of national coordinator, to use your metaphor, you have indeed been a sure bet that as part of such great heights already.

it's extraordinary what is happening last two years with respect to health information technology in the spirit with which you take our suggestions of recognizing their even more peaks to climb is exactly the right spirit that we should not forget just how extraordinarily far we have come in the course of the past two years under your leadership in the very hard work of your colleagues, site very much much like to thank you. the floor is open for a couple questions. i know a running mate, relative to the schedule we'd hoped for.? and so we might take five, 10 minute demos for questions, but several of us will be available to stick around and have subsequent conversations. let me throw the chair open to a couple questions if there areñ?? any.ñ?ñ?ñ?ñ? or if not, that's okay, too.ñ?ñ? the question in the back.?ñ?ñ? >> hi, i just wanted to clarify?

the congressional quarterly that she would move as quickly as possible on the recommendations, but they will be certainly challenges and there has been pushed back in the past from hospitals and from additions on interoperability. and i wanted -- this is a question for dr. blumenthal. i wonder how difficult will it be for you to implement this suggestion to the task force. >> we think the technical solutions are very promising and very interesting. we think it the right way to go. we are going to get feedback from our advisory committees to reassure us on that score. we're going to be consulting with the best minds in the country on the technical aspects of the implementation of these recommendations. and of course, and tell you get into the details, you can never

know exactly what the problems are. we are reassured by the fact that this is not new tech knowledge he. it's been implemented in other sectors of the economy, so earnest and strained to catch up with other such are spirit i think the unique thing in health care is for private security insurance is and we think that there are aspects of this set of solutions that would give us new capabilities in that area. so i think that on the whole things like very positive. there are a lot of very detailed activities to undertake common standards to write, implementation specification to write, implementation pilots, demonstration of feasibility and then the publication of all those things as open standards that are accessible to the industry as a whole. we've been doing this with other forms -- to create other forms

of connectivity. we have other projects underway than about creating a standards. so we have a sense of how much it's going to take and we think it's doable. the precise timeline i think one can plan, but we have to be open to the chance -- to the possibility that surprises would hurt. other questions?ñ?ñ? well, if not, let me thank all of you for coming and that mayñ? say that the pcast report itself is already on the pcast website. you can download it today. the request for comments by the onc is out by the end of the day. thank you: i want to thank our two speakers in the private÷? sector for coming and pointing to the future for us what is possible here. i appreciate your taking the time to come and join us. thank you. [applause]