ONC's Gettinger: IT 'takes a long time'

CHICAGO--Andrew Gettinger, MD, joined the Office of the National Coordinator for Health IT as CMIO and acting director of the agency’s Office of Clinical Quality and Safety last October, bringing a wealth of experience and expertise.

Gettinger also is professor of anesthesiology, adjunct professor of computer science at Dartmouth, and Senior Scholar at the Koop Institute, Geisel School of Medicine at Dartmouth and was formerly the CMIO for Dartmouth-Hitchcock and associate dean for clinical informatics at Geisel. 

Speaking with Clinical Innovation + Technology, Gettinger said his Washington, D.C., experience began a few years ago with a Robert Wood Johnson Foundation fellowship which exposed him to Senate committees including finance and health, education, labor & pensions (HELP).

Of the recent Senate HELP committee hearings on interoperability, he said “it’s important to have conversations about interoperability. The reality is is that it takes a long time. Folks sometimes think you can achieve your IT goals by just adding more people but that’s not the case. I say it takes nine months to deliver a baby. If you give nine women one month each, you’re not going to get a baby.”

Gettinger said healthcare has great interoperability in certain areas but no one thinks about it much. Electronic prescribing is almost universally interoperable, for example. While there is additional work to do, clinical content goes from one system to another. “That is interoperability.”

Another issue impacting interoperability is patient identification. In small circles, it’s easier to identify an individual, Gettinger noted. But, even at his own facility there were 120 different Peter Johnsons among the 1.2 million patients. “In a single system, it’s very hard to know who you are.” Scale that nationally to 330 million Americans and it’s a near impossible task.

One of the building blocks of interoperability is improved identification, he said. “It will never be perfect and we need to accept that there will always be some level of errors.” Congress made a fairly definitive statement about not putting any funding toward a national identifier but Gettinger points out that that statement was made in 1998 when healthcare was very focused on privacy and there was no Google. “We want to have a conversation. At Dartmouth, we have six FTEs devoted to fixing errors. It’s expensive. It doesn’t allow us to provide safe care. I talk about this as a person safety identifier. We have to know who you are.”

Healthcare remains a cottage industry, he said, which is a problem because “variation doesn’t allow us to develop a learning healthcare system.” Few institutions can standardize their data but the goal is standardization across regions and, ultimately, across the federal government. To get there, “we are trying to move to more standardized embedded content in the EHR.”

Another pathway to better patient identification is patients themselves, Gettinger said. “We are transitioning to an age where huge patient empowerment is coming.” Some organizations are working to engage patients in fixing errors in their records.

HIPAA allows for that, he said. “I hate it when someone uses HIPAA as an excuse for not doing something. They don’t take the time to understand it. Clinicians have been able to share information about patients as one of the permitted uses in HIPAA without any further restrictions. A lot of times that doesn’t happen or it doesn’t happen smoothly.”

When asked about the range of public comments ONC has received regarding the draft interoperability roadmap, Gettinger said there is a very active community responding. “We should not underestimate the diversity of the opinions expressed.”