The physician at the IT table

Shortly after joining the Office of the National Coordinator for Health Information Technology (ONC), B. Vindell Washington, MD, sat nervously in a high-level policy meeting. Midway through the meeting, the former emergency physician didn’t necessarily agree with how his peers would respond to the policy on the table and decided to speak up on behalf of providers. 

Afterward Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, gave him valuable advice in balancing his role and training as a physician. 

“Andy told me, ‘the worst thing I can do is be quiet,’ and that he was appreciative of me taking a vocal stance in such a high-level policy meeting,” Washington said. “That gave me some confidence and ability to keep bringing that different viewpoint to the table.”

Washington joined ONC in January 2016 as principal deputy national coordinator, working on utilizing technology to improve healthcare access, addressing the opioid crisis and furthering President Obama’s precision medicine initiative. In August 2016, he assumed the position of national coordinator, overseeing the nation’s health IT efforts, succeeding Karen DeSalvo, MD.

And now, nearly a year after sitting in that first meeting, a new administration means new leadership at ONC. He recently spoke with Medical Economics about his experiences as a physician at the federal agency and what he thinks the next steps should be for his successor and the agency.

 Medical Economics:How has being a physician helped you in your roles at ONC?

B. Vindell Washington: I think it has been very helpful. Like all new jobs, I was a little tentative when I first arrived and I wasn’t sure how all of my skills would translate. But I’ve been in meetings where I’ve been able to contribute a specific position perspective on behalf of physicians … or to identify personal drivers that are more universal for physicians. … I’ve been on the road to talk with providers, whether around the advancing care information portions of [Medicare’s Quality Payment Program] or around delivery system reform … 

I think it’s been really helpful for me to be able to connect with stakeholders and hear their concern through my lens as a provider being on the implementation side, responding to Meaningful Use stages 1 and 2, leading a health system through IT capital investments, leading a change effort around delivery system reform and preparation for our own accountable care organization in Baton Rouge.

I think bringing that to the table was something that contributed to the conversations we’ve had in the administration and I’ve received good feedback from my colleagues that they appreciated having a view from the field on the team.

 ME: You’ve had a short tenure at ONC, including as national coordinator. What do you think you’ve been able to accomplish during that time?

B. Vindell Washington: I think much of what we’ve done in my tenure is to push forward on setting the foundation for many of our initiatives that revolve around information flow and exchange. And so it’s really been about this pivot from much of the first seven years [since the HITECH Act] where we focused a lot on adoption and pushing the digitization of healthcare to a place where we can talk about information flow that in turn supports the larger initiatives put forth like delivery system reform, the cancer moonshot and precision medicine. I think we’ve made some great strides.

At its base, delivery system reform is creating a learning health system where discoveries are made, those discoveries in turn are pushed into broad clinical practice and patient-generated health data fuels both research and patient care. That all requires increased information flow. I think that is the next horizon.

I think it’s where I would expect my successor to continue to focus. It’s one of those things that had to come in this particular sequence. It would be impossible to talk about information flow before we were a fully digital health system. We’ve come really close …with 96-97% of hospitals and north of three-quarters of [U.S.] physician offices having digital systems in place.

Now it is about refining those digital systems and also making sure we reap the real value of having a digital system which again focuses on patients and patients’ wellness and the wellness of folks in the community as the real output of the effort. 

 ME: True interoperability continues to be elusive. How is this accomplished and what other challenges do you see for ONC for your successor?

B. Vindell Washington: The first is around the culture that exists around health information exchange. We’ve worked a fair bit with the HHS Office for Civil Rights with the work mainly centering around making sure patients understand they have rights to that information about themselves and that they can become more empowered in that space and more vigorous in terms of their participation, not only with their health issues, but also with their wellness and staying productive members of society. And making sure physicians and other providers know about the importance and the rights of patients in that space and the importance of information flow.

The second one is another partnership effort: around the business case for this interoperability. It remains a challenge as we pivot from fee-for-service strategies to more population-based payment strategies. It remains a challenge to make sure that the information flow that powers this learning health system is not entered into to the detriment of your fiscal bottom line-that you are making investments that facilitate your ability to reap the benefits of a connected system as opposed to being neutral or hurting your ability in that space.

The last area is around this idea of a standard for [data] communication. … Once everyone is using the same alphabet we want to be sure to be sure we are speaking the same language and using the same word structure to get to effective information exchange. It is really a complicated path.

I’m a provider and soon will be back at it again and you have to ask yourself:  How authoritative do you wish others to be in this space? And what role do you-doctor-want to fill in the space? On one end of the spectrum, [ONC] could have come out with a regulation that was very specific and told each of the EHR vendors where to dot the ’’s and cross the “t’s … and on the other end, to have sort of no role in standard-setting. 

I think where we landed is standard-setting for some of the high watermark areas, making sure we protect patients and their rights and provide some security standards for the operations that exist, but then leaning on what I’d call “the public-private partnership model,” to come up with absolute standards.

I think ... it’s the right place to land because when these public-private partnerships come together and produce items, they tend to be much more durable than if either had produced them alone. So there’s less of a threat of an administration change, changing a direction in what’s happening in that space.