Aneesh Chopra

Chief Technology Office of the United States

Served as Virginia’s fourth Secretary of Technology, January 2008-April 2009

Previously served as managing director with the Advisory Board Company, a publicly traded healthcare think tank

You’ve talked about how quickly new healthcare apps can go from conception to market today. What is your dream healthcare app?
Well, I have a 4-year-old and a 2-year-old, so I’m really focused on what it will be to make sure that my kids stay healthy. In this flu season, I can attest to the fact that this has been a stressful winter figuring out whether we take my daughter in, whether we don’t, how do we get her into the pediatric practice, if the practice is full, off hours. So we were constantly struggling with how to get basic answers to our questions. My presumption is that there will be better tools that would allow my family to feel much more empowered by the choices we have for our children so that we drop our anxiety, increase our confidence that they’ll stay healthy through this season.

As CTO of the United States, how much of your time is devoted to healthcare, compared with sectors such as energy and education?
I have five priorities for the president. Three are in the area of job creation, and those are ensuring that we have the infrastructure for the 21st Century economy. The president announced in the State of the Union a national wireless initiative that will provide coverage to 98 percent of the population and position us for development for 5G-and-beyond technology. So that’s an important chunk of my time. Second is this concept of entrepreneurship with “Startup America,” that is how do we bring the entrepreneur to healthcare, energy, education, public safety, you name it? So we launched on Jan. 31 the Startup America collaboration with Steve Case from AOL, who agreed to be the external leader of this movement. Zero taxpayer dollars. We collaborated with the private sector. My third responsibility is to think about the rules of the road on the Internet – so, how do we protect our children, how do we ensure we have privacy protections, what about cyber security, how do we think about the launch of property protection and economic growth on the Internet? So those three pieces are big and are part of our economic strategy. But my fourth item is to bring openness to government. So whether it is Medicare, or ONC, or any other federal agency, making sure that the method by which they execute policy reflects the president’s commitment to openness, more transparency, more collaboration. Last, but certainly not least, the president said when he announced my job, “I would like my chief technology officer to ensure that the harnessing the power of technology and innovation to dramatically improve the value of our healthcare system, lower cost and improve quality.” So, in that regard, a lot of work that is coming out of the PCAST report, healthcare IT program, the Affordable Care Act, is stitching and connecting the dots and have and have technology innovation catalyze some breakthroughs here is a very important part of my job.

What does the Blue Button mean for healthcare?
So this is just a simple idea. The Markle Foundation had a meeting in which they talked about personal health records and what will that future look like and what role would they play in it. And a number of folks, including Adam Bosworth, who was originally one of the founders of XML, said, ‘Wouldn’t it be great if there was a little button – maybe a blue button – that would allow patients to download a copy of their information and allow them to transport it wherever they go? Well, the VA, the DoD and Medicare all have repositories where patients enter in data. In the case of the VA, they augment it with clinical information, and more will come over time. So, we said, “Gosh, what a simple proposition. What are the methods by which someone’s been authenticated and already capable of looking at their information online? Once they’ve been authenticated and they’re in the system, why can’t they download?” And so, we put the challenge out there. The president, in August, said “I want this Blue Button capability, and I want it this fall.” He told the veterans – Disabled American Veterans (in fact it was the loudest applause lines in his speech – a speech in which he otherwise was describing the end of the combat mission in Iraq). Less than 60 days after his statement, the VA was up and running, as was the military, as was CMS, and we are now over 200,000 people. I think we’re approaching 250,000 who downloaded their information. We have a commissioned survey to find out what are people doing with their information. Most of them are retaining it for their records-keeping purposes. But we think there’s a new market going forward to provide upload features so folks could take that data and upload it to new applications and derive even greater value off the information that’s already there. We think this is a simple concept of the government of enabling or encouraging these kinds of innovations. There’s no reason on earth that every record holder can’t adopt a similar model of Blue Button. There should be data liquidity throughout the healthcare system. We’re just going to lead by example. We hope that others will join the trend, and we’ve heard a number of private firms talk about both the downloading ends of the concept.

Why is the Direct Project important?
We as a country have been talking about health exchange for years. I was secretary of technology in Virginia and I had worked at the Healthcare Advisory Board for nearly a decade prior, and we’ve been talking, talking, talking about information flows. And I was shocked at how little information flows. Now, I presumed we wanted to have this modern moment where everybody was wired up with electronic health records, and we had the ability to have data flow. At the end of the day, we should start to see information flow. It could as simple as me e-mailing you just my thoughts about your condition. It could be a much more structured note with CCD and all the information around it, but you’ve got to have information flow. Early here at my role in the White House, I said, “Why can’t we separate the transport layer from the content layer and (get) a group of folks engaged and … at a minimum, let’s just get a common agreement on transport.” Like there’s this thing called the Internet. It works. We need security. We need to authenticate, and we need to encrypt in between. This shouldn’t be very hard. It doesn’t require the invention of a new physics, if you will. This is a straightforward application of technology. So we’ve just got to reach consensus. So the stars aligned, and we said, “This is an enabling infrastructure for the healthcare economy. We need this. We’d love the private sector to develop this. We don’t need to have the government dictate this.” And the private sector stepped up. I loved it because the model with which it came about is the embodiment of the president’s open government policy. It didn’t require any fancy dollars or any big laws. It was literally a collaborative. I loved the method by which it happened, and I love the fact that its existence has meant dramatically lower cost and ease of adopting transport capabilities so information can flow provider-to-provider, provider-to- patient, provider-to-lab and vice versa.

How do you see mobile technology evolving in healthcare?
How our caregivers interface with the technology matters and what mobility has allowed us to do is to build dramatically simpler and more engaging interfaces. They just happen to be on a table or smartphone that we feel comfortable using. We’ve now in our culture accepted that we can engage in these tools. As a result, in my humble opinion, there will be a dramatic cycle of innovation just on how the presentation of the data comes to the physician or the nurse and how they interface the information back to the system. There will be a whole new art and a science to this. I know, having implemented large-scale IT systems in state government, how woefully poor we are in an IT sector dedicating the resources to improve that presentation layer. We’re so focused on the funding for the guts of the infrastructure and the interfaces and making sure that there’s security and reliability in the network that by the time the project gets to final delivery, we have these clunky user interfaces. And you hear it every day. You see it in surveys. This is an area where we have room for improvement. I think mobile opens up an excuse to put user interface top of the agenda and to see more competition around how to engage people. Mark my words, when we democratize some of these technologies, we create more of these substitutable applications, you will start to see not one, but two, three, five, 10 different models for how to do physician order entry. In a healthcare system, they may have a common engine for the transaction piece, but they might have a different method by which the cardiologists engage ER physicians, or what have you because there’ll be a much more engaging interface at the need of the caregiver.

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