New ONC chief Vindell Washington, MD: 'Time to pivot toward information sharing'
The Office of the National Coordinator for Health IT has seen its influence and agenda-setting power evolve somewhat over the past decade, but one thing is clear, said its newest chief, Vindell Washington, MD: The agency has helped bring the industry to "a place that is, quite frankly, astounding."
Consider healthcare organizations' adoption of information technology, "the fact that we're looking at well over nine out of 10 – 97 or 98 percent – of hospitals being digitized, and three-quarters of physicians offices being digitized," said Washington, responding to reporters' questions during a media availability on September 19.
"If you look at where people thought we would be when those programs started and ONC was sort of getting its sea legs, people have been astounded by that," he said. "When we have our sessions with foreign delegations, that's one of the questions: 'How did you get to this level of adoption?'"
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Now that adoption has reached such a critical mass, "it's time to pivot toward information sharing," said Washington.
Of course, interoperability has been a priority at ONC for some time – before Washington's predecessor, Karen DeSalvo, MD, made it a strategic imperative, before her forerunner, Farzad Mostashari, MD, made data exchange a centerpiece of Stage 2 meaningful use.
But now, Washington seemed to be saying, there was little excuse for further foot-dragging on robust and widespread information exchange.
ONCs approach to interoperability is three-pronged, he said, starting with the encouragement (and sometimes requirement) of nationally-recognized standards and the development, with CMS, of new approaches to the ways care is reimbursed, such as meaningful use.
But "perhaps the most important is working toward cultural changes in the sharing of information," said Washington. "We've done lots of work in that area with the Office for Civil Rights, making sure patients know their information can be exchanged and available when and where they need it for their care."
ONC generally applauds the advancements made by groups such as the CommonWell Health Alliance, the Sequoia Project's Carequality collaborative, Surescripts, and others, he added: "There may be different ways to exchange, and different structures around exchange based on the actual use case."
But "we're also particularly focused on making sure there's a level playing field, that folks are not left out," said Washington. "There's an opportunity to do more. There's more to be done."
Having most recently served as chief medical information officer at Baton Rouge, Louisiana-based Franciscan Missionaries of Our Lady Health System, Washington seen firsthand the value of having data from other health systems easily available in the patient record.
"When I was a provider – as recently as January – one of the things I valued the most about being digitized was the support I got from my electronic medical record in helping me avoid error," he said. "But also the information I could get at my fingertips to help me deliver better care."
The new ONC leader touched on several topics during his call with reporters, from patient identification ("there's some great work that's being done in the private sector – CHIME comes to mind – but it's an area that certainly needs some attention and focus"); privacy and security ("it's a human issue, not just a technical problem"); and the potential for emerging innovations such as blockchain ("we were all relatively surprised in the number and quality of papers" that were submitted in response to ONC's recent blockchain challenge).
But one matter on which he held forth at length was clinical documentation, spurred by discussion of the report earlier this month from the Annals of Internal Medicine, which found that for every hour a physicians spends face-to-face with patients, on average, he or she spends two more documenting the encounters in the EHR.
Beyond the essential note-taking needed to deliver and track quality care, of course, a significant volume of clinical quality measures and other data must be relayed to the government for meaningful use and beyond.
"When is enough enough?" Washington asked rhetorically. "One of the things that strikes me is that it is so different in different sectors of the healthcare environment."
To start, he defended information technology's role in helping create documentation efficiencies: "I (know) providers who implemented their systems, have great patient encounter times and go home on time or even a little bit earlier than they did."
On the other hand, he said, he knows others "are spending time at home documenting – time they'd rather spend with their families.
It's "a mixed picture," Washington admitted. "When the picture is so diverse we're probably still in an evolutionary phase when it comes to the usability of (electronic) records."
He emphasized that he himself, as a clinician, has struggled with the line between quality measurement and actual quality. "It's not an easy scenario. And it's often multifactorial. Asthma might have to do with whether someone lives in a polluted town, rather than whether they've taken their steroids or use their inhaler. In those instances, we operate in a slightly imprecise environment while we try to reach these goals of measurement."
But Washington promised that ONC has thought hard about both "the amount of documentation that's required to provide care, and to signal to others that you're providing care." And he said the agency will continue to push "toward that world where technology enhances the activity rather than putting a burden or pressure on it."