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Health and Human Services secretary Mike Leavitt said Friday that the government's existing advisory body on health information technology needs to be replaced with an entity that acts more like a corporate democracy than a political democracy.

Amid controversy over an HHS proposal to privatize the American Health Information Community, Leavitt led a public informational session to encourage collaboration among private and public organizations in forming the successor organization.

HHS is heading the creation of a new entity, as required under AHIC's 2005 charter. The current body counsels HHS on advancing the adoption of health IT. The replacement body would be an independent and sustainable public-private partnership, under the agency's proposition.

During the session, Leavitt compared apportioning power to the new AHIC with establishing the power structure of the U.S. republic.

"The question is, how do we create a governing process for this," he said. We have to "effect a transition in an orderly way" just as the founding fathers did in getting from the Articles of Confederation to the Constitution. "This meeting, in my mind, is about: Who is George Washington?"

While some stakeholders might want the leader to be the HHS secretary, Leavitt said, he would prefer that a group of organizations lead the new AHIC. His rationale is that health IT standards should be developed outside the political process.

If Congress or the executive branch created the standards, Leavitt said, we "would get it wrong, because we'd be working in a vacuum."

Those who have criticized privatization of AHIC are primarily concerned that the proposed offshoot would lack accountability and transparency. Several consumer advocacy groups, labor organizations and the seniors' group AARP maintain that HHS needs to retain an active role in governance to ensure that standards reflect the national interest -- not business interests.

Leavitt tried to reassure them by saying, "We have to be at the table as full participants because we're not only going to use the standards; we're going to enforce the standards." He envisions the government involved as a "major" participant because of its financial stake in the whole operation. "We're clearly going to be one of the biggest payers."

An audience member from the National Partnership for Women and Families, a group that opposes privatization, said, "History has shown that one big problem with the Constitutional Convention was that there were huge swaths of the population that weren't present at the convention." The woman said nonprofits and other small outfits could be excluded from decision-making if they can't pay board dues or contribute as much funding as private-sector members.

Leavitt acknowledged that ensuring equal participation would be a challenge but said he wants the groups that form the new AHIC to conquer the issue. "I'm not the one to do that."

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