ONC's new CHIO McCoy on interoperability, patient engagement, more

Michael J. McCoy, MD, recently joined the Office of the National Coordinator of Health IT (ONC) as chief health information officer and has spent the last several weeks adjusting to life in the public sector.

Bureaucracy has been “even more complex that I thought it would be,” he admitted to Clinical Innovation + Technology.

But, he took the position to put his clinical experience to use guiding the nation transition to a more interoperable healthcare system. That’s easier said than done because, for one thing, interoperability means different things to different people, he said. In his own experience as an obstetrician, he said there wasn’t always a uniform understanding of what was meant by excessive blood loss and how that can differ between vaginal births and post-C-section births and in other ways. “That’s a level of standardization that you have to get to for interoperability.”

To further complicate the situation, the same “standard” software package is implemented and deployed in different ways at different hospitals, he said. “Understanding how some of those challenges rear their ugly head and what we can do during the standards development and implementation processes—that’s where my background can hopefully be of value.”

The recent Senate hearings on the lack of seamless data flow “elevates the importance of interoperability and requires that we look carefully at how data is flowing and where there are impediments to the flow whether through intentional or unintentional practices that can be freed up by legislative relief.” He said the healthcare community also needs to recognize that interoperability and the technology are simply tools to achieve the goals of better health at lower costs.

Healthcare also is tackling the value-based payment transition and McCoy said we’re well past the tipping point. Just three to four years ago, almost no care was paid for through a value-based system. “Now, we’re moving to the 30 percent range in the past fiscal year. Healthcare IT is one of the linchpins supporting delivery system reforms. We have to have interoperability to communicate broadly for providers and hospitals to understand their exposure to different risks and be able to share data to avoid duplicative, unnecessary tests and derive better cost savings and outcomes.”

When asked about privacy and security in healthcare, McCoy pointed to the challenge of basic human nature. In some recent cases, “encryption would not have made a difference because data were accessed through individuals who clicked on phishing attacks that led to compromise.” Education and awareness is starting to have an effect on healthcare workers, he said. However, consumers need more education about general internet security as well as about their health privacy. McCoy said the interoperability roadmap has some gaps regarding consumer education.

“There is absolutely, positively a need for better patient engagement,” McCoy. Regarding a recent survey that found patient portals have yet to deliver, he said one challenge with making patient portals more effective is that “humans go places where they find value. If they go to a portal that doesn’t provide a full panoply of benefits or they have to jump through too many hoops, that creates confusion and lowers the value of that interaction.” Instead, physicians should think about how to better engage with individuals. Scheduling an appointment should be fairly simple, he said, but “there’s still a fair amount of pushback from physicians who don’t agree with that. But there is sufficient technology behind the scenes that can enable that if they let it.”

During HIMSS15, ONC will participate in several sessions and let stakeholders know that “we are here to understand the concerns of clinicians, developers and the healthcare community at large and do what we are able to to ease any burden. I understand the challenges and the pain. I want to make sure we communicate those pain points and do our best to alleviate them as we move forward.”

McCoy also wants to convey that there is life after Meaningful Use. “There are continued ways [ONC] may be able to help the community by looking at usability, flexibility and all of those things that would make life easier for users of technology but, most importantly, improve the outcome of healthcare for the individual.”