Vindell Washington to step down from ONC – exit interview

The outgoing national coordinator discusses interoperability, the promise of innovation and how he used a Palm Pilot to be a better clinician at the point of care. 
By Tom Sullivan
01:53 PM

Vindell Washington, MD, will be resigning his post as the head of the Office of the National Coordinator for Health IT effective on January 20, 2017.

Healthcare IT News spoke with Washington about his reasons for leaving, what’s next for him and for ONC, the issues of interoperability and innovation as well as how using a Palm Pilot earlier in his career made him a better clinician at the bedside.  

Q: This being an exit interview – when is your last day?
I’m leaving on the 20th of January.

Q: What’s next for you?
I’m still working on that. I completely enjoyed my time of service here at HHS. It has been a privilege, and a real eye-opening experience. My horizon has changed when it comes to what I think can be done in medicine, particularly around informatics. I feel like a role where I can make sure the tech is being used as a tool and we’re working to create a learning health system, that’s a passion of mine.

Q: The concept of a learning health system is a grand vision we hear a lot about. But how far off is it really?
It’s hard to know where the tipping point will lay. I’m happy with some of the developments over this period of time. I look at how we’ve strategized and focused on the business case for interoperability, the culture for that to be successful and the standards. The first two are just as important as the standards.

I look at work we’ve done with CMS and with OCR to knock down standing confusion around HIPAA and its role in information sharing. ONC also hosted challenge grants and the interoperability meds list work. Those elements are all coming into place. We had to take that broad approach to reach the goal. Many of us on the policy side are pretty excited and see a lot of potential.

Q: Are you stepping down on your own? Did incoming HHS Secretary Tom Price request it, or how does this work?
It’s a broad activity that happens across all political appointees - we all submitted resignations. No direct reach out took place.

Q: George Bush established ONC so it has roots with Republicans. Do you have any insights into what approach the new administration might take to ONC? 
I cannot comment on the new administration. I will make a short comment on the recent passage of the 21st Century Cures law because ONC provides tech support for that. There was quite deep and broad bipartisan support for that effort and it went through the process without much drag. We engaged heavily with all the chairs of the committee. We spent a lot of time with Sen. Alexander and Sen. Cassidy, so my presumption is that there’s a desire for the support work ONC does to continue as we move toward a learning health system. ONC is vital for that work.

Q: Is the learning health system something of a next horizon for ONC?
I might be bold in saying that the learning health system is the next horizon for all of healthcare. Person-centered care directed by evidence with clinicians receiving health information at the point of care is what healthcare will look like in the future. The discoveries themselves will be more rapid as you have larger and larger sample sizes from studies with more and more people participating in the evidence-generation process. When I was a med student 25 years ago we talked a lot about how these elements that were important, such as social determinants of care, would eventually help guide us and be studied and provide insight, and I remember specifically talking about pollution and pediatric asthma patients. Now we live in a world where we’re pretty close to being able to take data on pollution and take geography and exposure data from a smartphone and guide the care of disease. It’s no longer a pie-in-the-sky activity - that is pretty quickly where we’re heading. And we will all benefit from the more precise delivery of care that I’m describing.

Q: Data and EHR interoperability is among the thorniest issues in healthcare today. Is there an end in sight?
That’s an interesting thought. One of the conversations I had very early on is that there is no such thing as a standard that is static. I hope we reach a point from a cultural perspective that information is there when and where I need it for care. I would also hope that we reach a point where the business cases for sharing are pretty compelling. I would presume that just like other industries such as banking, the standards will continue to evolve as use cases present themselves and each of those will need to be incorporated. I think we are reaching a situation where the expectation is that information will be shareable. Then the nuance of interoperability will be a technology discussion as opposed to the one we started which is broad and encompasses domains other than the technology itself.

Q: In your time as national coordinator, what is one question that no one has asked you but you wished they would?
I sometimes wonder if it would be of interest to people how I ended up in this chair and with this particular passion. So, I come to this technology journey with a clinician's mind at heart, and I look at the entire endeavor around the smart use of technology and gadgets in service to the goal. The goal is patients getting great care and health outcomes being improved. That goes back to my early experience with having patients at the bedside and just hoping to do the best job I could and alleviate their suffering.

As a young resident I used what I had at the time - my Palm Pilot, which is in the tech relic bin these days - to capture algorithms and certain drug dose strategies that were relatively complex because I saw the role technology could play. Those things could make me a better clinician at the bedside. At the end of the day, making technology work as a servant to the overall patient goal is what I’m most jazzed about. 

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