Former ONC chiefs to DeSalvo: 'Just go for it'

WASHINGTON, D.C.—Former national coordinators for health IT came together at the 2015 ONC Annual Meeting to discuss the unique challenges of health IT over the past 10 years.

“We stumbled into” the health IT movement, said David Brailer, MD, PhD, the first national coordinator. People were “just waiting, I think, for government and leaders to say now is the time.” It’s really remarkable, he said, that the movement has sustained this level of passion and intensity over 10 years. Early on, "we tried to hone it into something aimed at creating political will. There’s a different flavor today and we need to determine how to keep it going and take it to the next level."

Industry has caught up with health IT, he said. When he started, very few in healthcare leadership roles were aware of health IT. “Health IT was not real or practical. It’s become very real now. In a lot of ways, we’re now demanding more and I think it’s tremendous to have high expectations.”

David Blumenthal, MD, meanwhile, had to set direction in the face of enormous uncertainty and incredibly tight deadlines. It was a "top-down effort to alert the healthcare community to the opportunitiess of health IT but it was also very much about taking the community with us and creating a market for what IT could do."

The resources are out there now, said Robert Kolodner, MD. "Now it's a matter of making use of them to have that impact on delivery and on health. The challenge is to take the resources now in place and have them really deliver the kinds of benefits that person-centered health and population health that takes a while as we get comfortable with the tools."

When Farzad Mostashari, MD, MSc, was national coordinator, “there was some concern about whether [Meaningful Use] Stage 1 had been too tough. We had done policy implementation but we hadn’t done implementation implementation. Top of mind was we’ve got the policies but now we’ve got to execute.” That was a very stressful time, he said, but times have changed. The Meaningful Use incentives were frontloaded so there was a huge push. “Now is the time for us to iterate and improve and take another look, maybe not on broad policy but on little implementations.”

“I feel lucky,” said Karen DeSalvo, MD, MPH, MSc, current national coordinator. “The catalyzing of the marketplace was very successful and we have reached a tipping point where all this data has been made available.” The culture has changed wherein people have realized that health is more than healthcare, she said, and takes more than getting people to a doctor. With the explosion of technology to help look at data outside of the exam room, “we have an opportunity to paint a bigger, better picture of a person and a population.”

Most industries have followed an innovation schedule of huge waves of change followed by periods of quiet consolidation, said Brailer, but healthcare doesn’t have that luxury. Healthcare has to move from its heavily architected, governed, centralized, uniquely unscalable infrastructure. What’s in place now, he said, represents the modern thinking of 1995. “We’re poised to take big leaps but we have got to get it right. I hope we get there because it’s essential.”

Technology isn’t preventing solutions in healthcare, said Mostashari, but current business practices are. “It’s fantastic to create a value-based payment environment where providers are incentivized to use that clinical data we’re not collecting but the vendors don’t have the same incentives as the providers. It’s better for the vendors if they get paid for every interface.”

Blumenthal agreed with a timely sports analogy: “You can be the Tom Brady of information exchange but if there are no receivers down the field, you might as well not show up.” Information exchange is a team sport, he said, and needs to be a collaborative, community project.

Vendors are getting mixed messages, he said, because we want our markets to be fiercely competitive at the same time we want the competitors to be good friends and share their most proprietary assets for no monetary gain. And, if they collaborate too much, they could be investigated by the FDA for antitrust violation. “Changes in payment are so fundamental to interoperability.”

Among legislators, the “level of health IT IQ has gone up dramatically,” said Brailer. When he started only a handful really got it. However, he doesn’t foresee the current Congress acting on health IT soon. He does think that a simple business model has begun to emerge in which there is a “simple recognition that health information sharing is a covered benefit just like having an MRI. It’s vital diagnostically and therapeutically and needs to be covered.”

When asked if they had any advice for DeSalvo, her predecessors shared a few thoughts. Brailer advised her to “very aware of the tremendous world that has been created by the health IT world. It’s a tremendous and rich movement.”

“The time is right for a real push on interoperability,” said Blumenthal. “The market is ready for it. The culture of change that’s been laid out is perfectly aligned with the time. Just go for it.”