Dr. Vindell Washington on health IT: Where should we go from here?
Dr. B. Vindell Washington has lived through a wave of healthcare change as a national leader in health IT. Federal healthcare programs such as Meaningful Use have encouraged a fast-paced adoption of health IT among care providers nationwide.
The Health Information Technology for Economic and Clinical Health Act (HITECH), implemented in 2009, charged federal healthcare officials with pushing for a widespread adoption of new technologies. And electronic health records have become the norm.
Washington now is the National Coordinator for Health Information Technology (ONC), where he has helped lead the way on health IT policy priorities and Precision Medicine Initiative, the interoperability Roadmap, among other initiatives. In an interview with Healthcare Dive, Washington touted the health IT advancements ONC has made over the past year. He also discussed how the next administration can help keep the momentum going with the same priorities in mind.
HEALTHCARE DIVE: The industry's new leadership may encounter some difficulties with the fast-changing health IT landscape. What have you found to be the most challenging in your role so far?
WASHINGTON: I’ve been struck with the complexity. I’ve certainly been struck with the scale. I’m confident at this point that there are differences in the way that healthcare is delivered in Sioux falls, or Tulsa, or San Diego, or where I live in Baton Rouge.
So I think one reason that healthcare and government regulations are complex is because we have a complex country. I’m not sure I truly recognized that until I got on the road.
HEALTHCARE DIVE: According to ONC, almost every hospital and health system in the U.S. has adopted a certified EHR. Yet you've called information sharing "the key component of this learning health system" and there is still a lot of work to be done in this area. Which of the three key concepts you mentioned during your session at the 2016 Connected Health Conference (business case, common standards, and culture) would you say is the most important for the next administration to focus on and why?
WASHINGTON: The idea about common standards is important. Technology-wise, it’s not particularly complicated to have common standards, but it’s like anything else where coordination is required. You have to select a series of standards.
You have things like continuity of care documents that we say an EHR vendor should be able to produce, but there’s still room even in that particular standard for you to produce a continuity of care document and someone else to produce a continuity of care document and they may not translate the same. There are levels of these standards that need to be done.
At a certain point, you need to talk more and more detail. That’s where we’re trying to be less prescriptive.
This is not a technology problem as much as it is a healthcare problem. When I was training and I wanted a 20-item chemistry drawn on a patient, the lingo was, I would stick my head out of the room and say, “I need a chem 20.” But so I moved to another part of the country and they don’t call them chem 20 -- they call them panels, and someone else might say, “I want a complete blood cell count.” and someone might always say, “I want a CBC.” So you have a surgical situation where there are a lot of colloquial pieces.
So some of this is not just work that’s happening on the tech side and I think that’s one of the reasons it’s important to have partnerships with the National Academy of Medicine, with the specialty societies who are working through these kinds of issues and discussions so that when it is time to submit information or review information nationally, that I can look across those different geographies and come up with a single definition.
HEALTHCARE DIVE: Many care providers have hesitated to adopt healthcare technologies, and there is consensus that is at least in part due to the culture among older generations. How should ONC collaborate with other members of the healthcare industry to ensure more voices can help change the culture?
WASHINGTON: We work very hard to ensure that the policy concerns and the direction from us is clear and that we’re presenting a coordinated face to the community, and the CommonWell Alliance and others have pointed out areas where we, from the federal perspective, can be more helpful in advancing policy priorities by engaging or using our position as coordinators or working with our federal partners to support that effort.
There’s a lot of work that’s done outside of regulatory work, and outside of states and working with the Hill. I think if you have something that’s evolving as quickly as this, I don’t think we want to get in a situation where we are dictating regulations and dictating business practices.
The idea of these public-private partnerships, and that includes the Interoperable Standards Advisory or the Policy Advisory or the work that we do in these stakeholder listening sessions -- I think it makes for, in some instances, a more durable project and a more nimble project.
You get together and you decide on what common goals and outcomes should be, the folks who are the doers, the folks who are consultants, the folks who are the consumers are all around the table for that and then it makes it less critical who sits in my chair. I think this is a good way to keep the policy goals in line, but not have to be tied to a stranglehold from a regulatory perspective that hampers creativity.
HEALTHCARE DIVE: With the increased focused on personalized care, what should the Trump administration know about the potential of precision medicine?
WASHINGTON: This move toward more personalized medicine and the role of genomics and personalized health data, including patient-generated health data, is the next horizon. Precision medicine offers something that’s completely different from a medication perspective.
We’re going to be able to provide more personalized care. In my case, African Americans often have more volume-related hypertension so they sometimes respond more to diuretics. That’s a pretty generic category particularly given the genetic diversity among African Americans in this country.
As we move forward and bring in those other elements, you can bring in the fact that I live in this particular area and I have this amount of, say, pollution exposure and I’m out of the house this portion of time to what my treatment regimen should be. I know that because of my GPS location on my phone is because of the weather and satellite data that are layered onto my healthcare data. That helps decides what my best treatment is.
This is an initiative in a series of thought processes around precision medicine and personalized care, which is only going to be more important and more centered to how healthcare is delivered in the country. I’m really looking forward to that.
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