 Thank you very, very much. I'm very pleased to be here. I send you greetings, bring greetings from Secretary Sebelius and from Dr. David Blumenthal, the National Coordinator for Health IT. First, I think I should say that Dr. Frank Bryant Jr. is a legend and we at the Department of Health and Human Services are honored to have been asked to join in this discussion today in reading about Dr. Bryant. I'm overwhelmed by a service to this community, to our nation and actually to those who care for the infirm. He embodied the love of his fellow man that was manifest with the love of medicine. We need to be more mindful of legacy such as his. And next, before I really get started, I really have to give a disclaimer. I'm a big believer in the adage that content without context is pretext. So I always like to warm my audience up front that I'm a surgeon. So now you'll know and you'll understand why in the final analysis I frame every discussion as if it is all about me. It is very, very true that every surgeon is a direct descendant of Narcissus. Now, having said that, you know, we are in a moment of transition. Years ago, when I studied chemistry, I learned that the transitional state of reaction is where some of the most fascinating activity occurs. In business, Andy Grove, the former CEO and chairman of the Intel Corporation, took great interest in transition points. In his book, Only the Paranoid Survived, he labeled some business transitions as strategic points of inflection, the time when the fundamentals are about to materially change. Business, chemistry, my surgical practice, life, transitions are very interesting things, which is why I chose my title very carefully. These times are very interesting. And in this interesting and hopefully meaningful confluence of forces, I see a moment. Now, my clarity around this moment is not based in the future perfect tense. Don't get me wrong. This will have been a definite period of importance and consequence, but that's not the moment that I see. The moment I see is due to a confluence of forces, and so my title is really reflecting the moment we studied in physics, that of producing motion about a central point or axis. And that point, the point I believe that everyone today is circling is the quality, the completeness, the value of healthcare services delivered in the United States of America. So I'm electing to use that less-frequent meaning of the word moment to highlight that at this critical juncture, at this crossroads, the decisions we make will all be active ones. See, too often I hear the debate about healthcare reform posed as a choice between an active change and a passive decision to let this both go by and stay with the status quo. It is critically important for everyone to understand that whatever your feelings about it, the status quo is not solid ground. We are not currently safe on shore on dry land. We are not in safe harbor. And in fact, we are on course, as you've heard already, for a destination that can be described with horrific arithmetic certainty. Left with no changes, Medicare will be insolvent in a generation. Millions of Americans do not have access to affordable healthcare and their numbers are growing every day. The status quo also means that people of color will on average continue to get inferior care. So let's just be blunt. We're not having a picnic here. And thrust right into the center of this debate is a question for my office. What is the role of information technology in the larger discussion of reform? Well, I will say that there is no doubt that the appropriate application of digital electronic information tools can solve many of our collective problems in healthcare. It can be a tide that raises all boats. Well, that's the good news. The bad news is the larger reality that not everybody has a boat. Now, I've been a bit hyperbolic. No, not in the fact that multitudes are without reasonable access to care or that those that do have access get wildly variable levels of quality in that care. No, the hyperbole actually rests in a tacit assumption that health IT is the high tide. In 1998, Cyril Shantler pointed out that medicine used to be safe, simple, and pretty ineffective. Today, medicine is much more effective, but much more complex and potentially dangerous. While some of that danger can be mitigated with well designed computer systems, I often worry that some may be selling a little bit more than the digital revolution can deliver. Don't get me wrong. While I have an firm conviction that properly applied information technology, properly applied tools can help me as a surgeon become more mindful of my patients, learn new insights into the care I deliver, and help me improve the quality of that care, I've heard some say that computers alone are the answer to our problems, that they are a panacea. Well, we have to be very careful because some of the hype tries to make the case that if we just really wait for the folks who gave us Google or eBay, everything will be just fine. Well, I have to admit that we do have significant technical issues around bits and bytes, but in that same breath, I tell you that our greatest challenges are greatest issues are actually cultural. You see, while I'm here to tell you how our office is going to try to get a computer in every practice, and the country is important that you first understand that health IT is just one piece of a much larger solution. The other questions that we must answer to overcome our current inertia in American health care are in part related to how well we can distill patient care into a series of ones and zeros, but it's also equally related to the structure of payment policy, as you've heard. Our current legal environment, the growing consumer empowerment movement, and a clinical establishment that is schizophrenically loyal to both anecdotal practice phenomenon and randomized control trials. So, you see, the open question is not, can we put all the stuff of my practice into a computer? The real question is, can we use information technology as a vehicle to change our culture and in turn our methods in 21st century American health care? So I'm hoping that you'll keep an abiding appreciation for the fact that all of our problems in health care will not vanish on the morning of that great getting up day when there's a computer next to every stethoscope. So, let me give you some of my take home messages. The first thing that I want you to take home is that at this moment in time, probably more than any other, is the time for physician leadership. And while we lead, we must be the first to acknowledge that medicine is a team sport and any success we have is wholly dependent on the strength of our team. Next, you have to understand that our circumstance is not due to a lack of technology and therefore technology cannot be the only tool we use for a solution. And finally, you must rest assured that no direction beyond this point is easy. And while I won't promise you only blood, sweat, toil and tears, we have to understand that the path forward requires a system, tremendous resources and no small amount of courage. That's it. That's what I have to say in a nutshell. But let me spend just a minute on my second thought. And although Francis Peabody didn't speak to the issues of computers in his landmark address, his wisdom is relevant to this discussion. To say it another way, I can echo Michael Porter, who published remarkably similar sentiments nearly 80 years ago to the day after Francis Peabody. To paraphrase them both, I will say that this is all about value and values. So I hope that I'm clear. Health IT is not why I am here. And now that I've been a real killjoy to the whole topic, I have to say that there is a great deal to be hopeful for of because change is underway. In health care, we're clearly in a transitional state and now the down payment for that change has been the high tech portion of the Recovery Act. So in it, we here have clear direction to facilitate meaningful use of electronic records nationwide. And we also see throughout that the overarching subtext is to improve the quality of care while making sure that the information remains secure and supports our institutions of public health. To improve, to ensure, reduce, to facilitate, promote, protect. This is a pretty formidable list of challenges. But again, I ask you to take note that the transcendent goal is not to acquire cool hardware. The point is not to have the latest software. The infrastructure is a means to an end or it is nothing at all. And Congress has given Dr. Blumenthal pretty tremendous resources, but let's be honest, the task at hand is pretty incredible. Looking at our practicing physicians, we can see that only 4% are using an electronic health record that can do the work that we really need. That is handle progress notes, order labs, meds, x-rays and view the results. And why is that? Why are we at 4%? Well, the answers are pretty clear. Here we see the top six barriers to adopting an EHR. In short, for many in the clinical community, we've collectively said that it's not been worth it. We've been clearly saying that to embrace electronic health records, our needs have to be met. Our needs really must be met. Now, I use this slide nearly everywhere I go because I find it such a wonderful construct to frame our challenge as well as our solution. This is a diagram from the work of Abraham Maslow who in 1943 described the theory of human motivation. In it, Maslow essentially divided our needs into growth needs and deficiency needs. Deficiency needs are physiologic. They must be met first. And once met, the individual seeks to satisfy the needs of growth. Well, we can apply Maslow's hierarchy to our current circumstances and health IT. And in doing it, we will assign the foundational need as privacy and security. Beyond that, moving up the needs of growth, we see the components of usability, basic functions, a strong business case. And finally, at the top, a most fulfilling achievement, information exchange. Now, let's look at how those requirements will translate into action for our office. I mentioned earlier that privacy is the foundation for moving forward. And the reason is obvious. The tenets of privacy are old in our profession, and the Recovery Act clearly speaks to this point by providing resources and properly expanding the boundaries of HIPAA covered entities. The Act also mandates detailed plans outlining protections, and most importantly, how our department will lead increased enforcement of privacy laws and regulations. Now, one level above that needs the immediate issues of how to choose and effectively implement this technology. A few weeks ago, the department released a framework regarding how we can help physicians with the technical assistance to health IT regional extension centers. Excuse me. The goal of these centers will be to provide hands on technical assistance in implementing this technology. They will do this for more than 100,000 physicians, and our office will spend nearly $600 million on this assistance. The staff in these centers will include some ubergeeks to install software and configure hardware, but they'll also include some folks that are trained in the nuance of clinical work that know how to lead practices through the steps of changing the way patients flow through their offices. Physicians to a large extent are naive about such matters, but I always considered that a pretty admirable attribute, not necessarily a flaw. Now, as we begin to discuss, it's critical that everyone understand that this is really no place to have your high school age nephew set up your office EHR. This is a serious endeavor, and our intent at HHS is to create durable, measurable, reliable improvement in health care. But of course, we need to have more than a policy of good intentions. The Recovery Act provides serious provisions to address two of the most vexing issues, the initial cost of implementation and a tangible return on the investment. The resources available for this are about $19 billion. Now, in preparation for this, we're going to have a proposed rule, and we're asking everyone to invite, proposed rule means that we'll have comment. We're asking everyone to provide comment for that, and you'll see a URL where you can provide that comment at the last slide. But while the details are still formulated, I can note that the Recovery Act gives clear contours for meaningful use. The EHR has to be certified, and it has to be on a trajectory for including for the exchange of information. And again, this speaks to my central thesis, namely that our current circumstance is not due to lack of technology and cannot be solved by technology alone. It is no small matter that the statutory criteria for meaningful use involve information moving, information exchange. The whole point is to provide a means to facilitate communication and the transfer of information, and possibly even the transfer of knowledge. In the right hands, at the right time, information can be transformative. And that's why health information exchange rests at the top of our hierarchy. It's analogous to Maslow's self-actualization. The full, complete, rapid, and regular exchange of information will represent a singular change in our culture. And I can think of no better way to increase the value of our services than to make their provision fully informed. The alternative is equally remarkable. To continue each of us in our own silo, putting one innovation on top of another, with no real consideration of how one piece of information informs, supports, or confounds, another means that we will keep our current haphazard and dysfunctional method of taking care of patients. It means that we will recreate the experience of Babel. So you see why earlier I emphasized that computers are not the answer because the question is not how much technology do we need. The question is how do we improve the quality of care for all Americans, and in turn affect that elusive yet self-evident truth that means that all among our unalienable rights are life, liberty, and the pursuit of happiness. Now is that hyperbolic? Well no, not really, because I've seen that the pursuit goes slower for our kids that aren't immunized. Preventable cancers have separated far too many from their right to life, and the full flower of liberty is not as apparent to those that rise every morning with a disability with Alzheimer's or HIV. Now a computer won't make that right, but electronic records can assure that a pediatrician sees a list every morning of the kids that are not up to date with their immunizations. Every man, woman, and child having an electronic record means that our best minds can ask and answer the question, what treatments work best for a 48-year-old Latina with breast cancer? A computer won't rid the world of AIDS, but it will afford well-meaning people the liberty of having their care coordinated in such a way that their doctors know the results of all of their tests. Let me finish up by saying that nine years ago the Institute of Medicine got it right. Good quality care should be effective, efficient, safe, patient-centered, equitable, and timely. But just saying that won't make it real, and it only begins to describe what we need to do. With information systems, we can see the true choices and the balance that must preserve, a balance that really is highlighted in my reality as a 21st century American surgeon. You see, I know that in the operating room you can be no more efficient than you are safe. I know that in the world of surgery, effective treatment is synonymous with timely treatment. And I can tell you that in my world and that of my family, you can't begin to think about providing patient-centered care without a full measure of equity. So I'll close this discussion of health IT, hopefully leaving you with an appreciation of the fact that our use of technology to master this domain or any other can only be meaningful if it supports an abiding pursuit of the grace to care for those that share this moment with us. And if we can do that, perhaps we can know a truth that the Jesuit philosopher Deschardin foresaw that for a second time in the history of the world, we may be able to discover fire. Frank Bryan understood this, and I've been honored to stand and say as much in his behalf. Thank you very much.