Robert Kolodner, MD, admits to keeping a low profile following his stint as interim National Coordinator for Health IT, a position he left in 2009 after a 31-year government career - three years at ONC, and before that 28 at the Department of Veterans Affairs. As chief informatics officer at VA, he led the development of VistA, the department's open-source electronic health record.
Low profile notwithstanding, Kolodner has been anything but idle. It's just that he prefers "to do and then talk," he says. A new collaboration between Georgia Tech and the VA on health IT innovation has Kolodner talking. The forging of partnerships like this one, which Kolodner was instrumental in achieving, is the focus of this "recovering fed's" new work in health IT.
His primary work has been as part of the team at Open Health Tools, a multinational nonprofit organization whose tagline is: "Improving the world's health and well-being by unleashing health IT innovation." It's what Kolodner is committed to help realize by forging collaborations among diverse groups.
Open Health Tools springs from the Eclipse Foundation created by IBM in 2001 "The people who started that wanted to do something in health and healthcare," Kolodner said. They started Open Health Tools using the same model, bringing together competitors and a diverse range of participants "to help make significant advances in what we hope will help contribute to and transform health IT," he added. "What you're seeing with the VA-Georgia Tech collaboration is one aspect of the many pieces that are needed to create the resources and the environment and enable that to occur."
Q. How did the Georgia Tech collaboration come about?
A. It was something that turned out in retrospect to be a natural collaboration, a natural alliance. The two organizations both had been working in ways to stimulate innovation. VHA's activity was around its Innovation Sandbox. Georgia Tech has a long history of fostering entrepreneurs and businesses. They received a grant - contracts from the Department of Labor and the Department of Commerce - in order to achieve job acceleration. The funding that Georgia Tech received had an emphasis on helping retrain and employ veterans and to foster businesses that were led by veterans. In order to do that they needed a laboratory for hands-on experience and their goal with that was to really foster innovation - especially disruptive innovation.
Q. What do you imagine as some of the tools that might come out of it - some of the innovations for disruption?
A. I think one of the most wonderful things that could come out is that it really sets the stage for this broad collaboration among different participating organizations and individuals and would grow into a nationwide health IT innovation network - a virtual network that would connect different organizations, public and private, educational and commercial. This network enables new innovations to occur much faster and at a much lower cost. By having the resources available, there's very little startup time necessary between the idea and actually testing it out with real products, whether it be open source or commercial. This innovation network would enable advances in personal health and population health as well as in healthcare and the IT resources, infrastructure and solutions that can help us in all of this area.
Q. So it would be big.
A. Big, but big like the Internet. It grows as something that is natural and it attracts the participation. I think if you try and plan it - if you try and build it - you'll never get there. If we had tried to plan what the Internet was going to look like today we couldn't have done it, but it could grow that way. I think that there are a number of things - a number of examples like that that they are far too big and complex to be able to build. But over time, through small advances, they can grow, and when they get good enough, then more people join, or more organizations join, and new innovations occur. It has to be very iterative, and the first time through it's not going to be exactly right, so you start small with those early adopters who are willing to try and you make sure that it's not very expensive and not very big and then as you iterate and get it better an better.
Q. What might be the biggest challenge you might face?
A. The challenge is how do you get groups of diverse organizations and people to collaborate. How do you get started? How do we lower those barriers to participation so that it becomes fair and equitable? We want to eliminate disparities so that this isn't something that just helps those who have resources. We know we want a level playing field so both large and small organizations - even individuals - can participate because many of the innovations occur from places you never would have imagined.
Q. What part of healthcare is most in need of innovation in your view?
A. I think there's tremendous opportunity for improving the quality of healthcare across the nation and even around the world, and there's unevenness. There's high quality, but there's people and organizations and communities that don't have that available. There's one aspect that has to do with resources that you have, facilities that you have, care providers. Another part is the gap between the knowledge and the delivery. So even in places where they have resources, some might have the knowledge about how to improve a condition or how to help individuals to change their behavior and how to engage them effectively in improving their own health, and yet others don't have that knowledge even though it exists. We talk about the 17-year gap between knowing that something should be done and when it is done for even 50 percent of the population. Closing that gap - making sure that if something can be available widely and doing so in a way that doesn't overwhelm the care provider or the individual with information, I think that's a theme that runs through healthcare not only in the U.S., but also around the world.
Q. How did your time at ONC influence what you do today?
A. I'm really concentrating on networking and bringing groups together that share common values and visions and objectives, but often they don't know about one another. I'm working to introduce them and help them find opportunities to collaborate. This often involves introducing competitors to collaborate. Not a new idea in many cases, but doing it in a way that really does achieve that neutrality and one that can tend to the broader good of the advancement of health and wellbeing and yet can create opportunities for companies - particularly innovative companies - to profit. That is also opportunities for individuals to have affordable solutions available to them. Having those two together is something that is very important. My stint at ONC and my time at VA really are the things that inform my work.