Dr. Vindell Washington's time at Health and Human Services may have been short, but his impact on the future of health IT will be influential.
After becoming director of Office of the National Coordinator for Health Information Technology in August, Washington has helped guide HHS's campaign to make electronic health data shareable between health providers and giving data rights to patients.
Washington spoke to Senior Staff Reporter Carten Cordell about the accomplishments of his tenure and the future of interoperability in health care.
You're almost a year into coming into The Office of the National Coordinator for Health Information Technology and about six months since you became ONC director. Can you talk about the accomplishments that you're proud and how you helped move the ball forward on interoperability?
It's been a great experience being a national coordinator and coming here to HHS to work. I think we've particularly been happy about being able to participate in the major health initiatives of the administration. Those would be delivery system reform, the precision medicine initiative, the Cancer Moonshot. And our main focus on all of those has been to provide the infrastructure for those to work. And by that I mean really focusing on having information flow between providers, between patients and to research institutions and public health entities in order to facilitate those major initiatives. I think those are the accomplishments I'm most proud, how it fits into the whole.
What advice would you have for your successor in terms of continuing the infrastructure development?
Well, I think first, it's best to recognize that it is infrastructure, and focusing on its importance, I think can't be overemphasized. I think if you take your eyes off the ball of interoperability, a lot of things can fall off the plate or to the table. When we think about interoperability, we really lean in on strategies to push it forward and that takes a lot of collaboration.
My advice would be to be very quick to reach out for the public-private partnerships we've had, to work with our federal partners in that effort. And our focus has really been on three main areas, that's work on the business case for interoperability, working on the standards for interoperability and trying to change the culture around interoperability.
What were some of the challenges you faced on the job, how did they inform your approach to it and how may they inform your successor's approach?
I mean I think there are a lot of challenges when you take any new position. So there was a lot that I had to learn about federal service and a lot of that I had to learn about just the book of acronyms to sort of function in the place. I think I was lucky in that I had a pretty deep experience in health IT, had a pretty deep experience on the operations side of really how to navigate through the use of technology to improve care, to reduce cost and to make things more efficient. So I spent most of the time here in the transition learning how to take those skills and that perspective and bring it to policy. Making sure that we were not doing things that took away from those overarching goals, stripping down sort of sometimes the more ethereal approaches and the more kind of whiteboard-approaches to things that were practical and tactical as we worked our way through.
We had a lot of large initiatives this year that were aimed at long-term policy efforts, things like [Medicare Access and CHIP Reauthorization Act of 2015 Quality Payment Program]—changing the advancing care information initiatives from the previous meaningful use for individuals, a lot of work on the interoperability standards advisory, a lot of work really on those major initiatives we spoke about—the delivery system reform in particular—all required us to do that work. I would say that transition from the private sector to the to the public service, and the focus on what that means, I think was a lot of the effort early on here in the office.
What kind of steps you think are needed to pursue that momentum with interoperability in opening up health information and making sure it flows?
So let's go a little bit more deep in this discussion on those three prongs of the approach that I was referencing earlier. So how do you increase interoperability? We had a great session [on Jan. 6] with Vice President Joe Biden, and we were discussing the Cancer Moonshot. And one of those questions on the table was how do we move this effort forward? How do we advance in this space? And it was interesting to me how quickly we settled on three main categories that we've been pursuing in general for interoperability and, then in specific, they support the Cancer Moonshot. So many of the folks around the table brought up this idea of business alignment. So if I have to invest to have information flow more freely, how do I make sure that as an entity charged with making good capital investments that investing in information flow falls in my top 10 of things that can get funded and that remain at number 12?
So a lot of the work around Accountable Care Organization work, around comprehensive primary care models, around these payment models that emphasize taking care of the patient and a group of patients longitudinally and over time are things that sort of push this idea of information flow and stresses the need for that. We spend a lot of time talking about culture. So what is it that I expect as a patient? What is it I expect as a caregiver? Do I expect to work in the dark or do I expect information to be available to me as a caregiver? As a patient, do I expect to be empowered with my information? And so a lot of the work that we started with the Office for Civil Rights in this space, we're making sure that people understand their rights and their information, making sure that providers are not overly focused on any barriers that they may perceive with HIPAA and information flow and focusing on really what's required for information flow under HIPAA. To talk about really what it means to patients and their families when information flows well. So changing the culture is that piece.
Then lastly, this idea about standards. One of the things we celebrated with the vice president was the fact that we had in December celebrated a display of interoperable medalists where applications were developed by vendors to work across information systems to pull information to provide to a patient to empower them around their medications. So you could go through any door, receive information from potentially competing vendors or competing health systems all for the benefit of the of the patient. I think those three elements, those three approaches, are probably the most critical in moving the ball forward. The session, in my mind, was almost sort of a both a pat on the back for getting to that mile marker, but also, in my mind, painted the road forward, which is to say continuing to lean in on those three items is in my mind the most likely thing to lead to success and information flow in the health ecosystem.
With those things accomplished, what is your hope for the future of interoperability down the road?
I thought about that an awful lot in the last few months. I think my best hope would be that information flows in such a way that creates kind of all a learning health system. We talk about that term relatively frequently, but when I use the term I mean a situation where research institutions and public health institutions, as they make discoveries and have directions to provide to practicing providers, that they are able to push that information in such a way that it lands almost real time in the workflow of providers for their consideration so that discoveries don't remain locked up in the silos that sometimes happen as research is not necessarily distributed as freely as we would all like for it to be. And that the information technology becomes a tool, sort of helps doctors do things that they would not otherwise be able to do, I think that's the highest goal.
Then as we look at what happens to the patient-generated health data, I still remember the days where you would hope that patients brought that list of medications in to you so you could sort of help figure out what your next step might be. Or if you're on the research, they would be able to provide to researchers or donate or participate in their care and the care of others, use the altruism that that exists in our society generally to help drive innovations, that’s the highest goal in my mind of the information flow. It is nice, from a tactical perspective, to be able to perform better in a payment model that rewards coordination and collaboration.
But the highest goal is to have that coordination and collaboration, that use of best practice, be the norm and in year after year, patient after patient, have the care improve that's delivered to each individual. That would be my best overall hope for the health system in general and IT plays a role in that. But I think many of the changes both from a cultural perspective, from an expectation perspective, are things are also required to support this. I'm just very excited about kind of where we stand with the ability to look at that as a real potential versus years ago where we really didn't even have a digitized health system so that information was sort of locked on paper in someone's office as opposed to at least having the ability to have it flow more freely.
