Michael Hodgkins, MD, is no stranger to either clinical practice or information technology. As a physician, his training was in internal medicine. As a technologist, he had spent 25 years working in healthcare information technology, much of it with startups focused on information sharing.
Now, as the chief medical information officer of the American Medical Association, Hodgkins can bring all those experiences to bear. With the AMA since 2010, he is now deeply involved in health information technology (HIT) initiatives, as the organization ramps up efforts to represent physicians’ concerns and ensure that HIT helps physicians in practice. “I’ve been able to capitalize on my technology experience and deep knowledge about clinical practice and the clinical ecosystem in my role, and contribute to the AMA’s discussions about strategy and policy,” he says.
In his role as CMIO, he is responsible for AMA strategy in the digital health space. In addition, he informs AMA policy and advocacy on all aspects of health information technology and represents AMA on the board of The Sequoia Project and chairs the steering Committee of Carequality.
Health Data Management Editor Fred Bazzoli recently interviewed Hodgkins on his leadership position in Carequality, a public-private, multi-stakeholder initiative that has come together to enable information exchange. It uses a consensus-based process to enable seamless connectivity across all participating networks.
What is the AMA’s role in supporting The Sequoia Project? How did this interest come about?
The AMA became a founding member of Healtheway, which was rebranded as The Sequoia Project last year. I’ve been on board since the beginning when it was Healtheway; I represent AMA on the board now. The motivation ties back to our constituency; the priority we have had is to support information sharing, because it’s a prerequisite for a more efficient healthcare system that can drive better patient care and sustainable physician practices.
In what ways is the AMA supporting the Sequoia Project?
I’m a very active voice as a member of the board, and I also chair the steering committee on Carequality under The Sequoia Project umbrella. We participate in all board decisions, contribute to position papers; our policy experts regularly interact with The Sequoia Project CEO and staff to achieve alignment from a policy and advocacy perspective. Carequality also has a large and diverse advisory group that has helped in shaping the implementation framework that governs network to network information sharing and is helping us to prioritize new use cases for Carequality that will enhance information sharing in support of better and more efficient healthcare. We’re trying to ensure that the physician’s voice is well-represented in decision making.
While The Sequoia Project has been an ongoing concern for a number of years, Carequality (a community within The Sequoia Project) is a more recent initiative. It uses a consensus-based process to enable seamless connectivity across all participating networks. Last year, Carequality spent a lot of time developing an initial implementation guide for patient record queries. As a first step, five vendor organizations will be implementing the framework, and other use cases are now under development. Carequality is rapidly adding new partners from across the healthcare spectrum.
Where does this initiative fit into the current mix of movements working to achieve interoperability?
The Sequoia Project is a public-private collaborative—it connects industry and government, and it’s set up as a non-profit to support the development of a nationwide health information network–the eHealth Exchange. Carequality is looking to develop a network of networks; all the implementers have their own networks in place, and instead of trying to get everyone to adopt one network, we’re creating a network of networks, and we feel that this approach opens the opportunity for true nationwide health information exchange.
No one really expected one organization to do everything. Some initiatives focus on convening participants to support standards, others work to achieve national exchange. We’re not the standards organization, but we’re really trying to provide governance for actual operating exchange. Because our members are both public and private, we’re completely open to anyone—we’re the “big tent.” While developing principles and policy is important, it’s not enough if you can’t operationalize it. On the other hand, if you have an operation, but it’s not founded on broad stakeholder participation, and it doesn’t offer a shared vision and principles, then it’s unlikely to be successful. By combining these, and having an operational model, I think we’re achieving a great deal of success.
Why is this project important for the AMA constituency? How does it fit into the current scope of concerns that your members have, or are you hoping to head off future challenges for them?
The whole idea of interoperability—unimpeded information exchange—has been a core concern for physicians since the inception of the Meaningful Use program. Right now, EHRs are just another silo; an electronic version of the paper record. It is very limited in what it can do to improve care. We have to have EHRs that can easily exchange information. The whole area of EHRs and electronic health exchange has been a concern for a while now.
The AMA and RAND Corp. collaboratively surveyed physicians on the topic of professional satisfaction in 2013, and EHRs was one of the key sources of dissatisfaction, particularly the lack of interoperability and poor usability. The level of dissatisfaction with EHRs, and the lack of interoperability and overall usability, are important contributors to physician burnout—EHRs are not the only reason, but they are a leading factor. As we really start to transition to value-based models of care under MACRA, interoperability is absolutely a prerequisite—there’s no way to deliver value-based care without access to shared information.
The Sequoia Project is just one of many ways in which the AMA is taking a more proactive role in healthcare IT. What are the priorities driving this new interest?
We routinely interact with federal agencies on policy matters. Beyond that, the AMA is part of the advisory group for the SMART initiative (which encourages an open, standards-based technology platform to enable innovators to create apps that seamlessly and securely run across the healthcare system). The AMA is also a partner in MATTER, which is a Chicago-based health technology accelerator. We are the founding partner of a new innovation company —Health 2047— in San Francisco. We’re getting deeply involved in the health IT space; we want to make sure that the physician voice is represented in how these tools are developed. The promise of healthcare IT is that it can overcome the limitations of a very fragmented healthcare system. If you don’t do that, value-based care is not achievable. A lot of physicians feel like they’ve become the tool of their tool. We want to make sure they have access to the tools that they need, but those tools should stay more in the background so it doesn’t diminish the interactions they have with their patients.
Tell us a little about yourself. What is your background in healthcare IT, and how does your role at the AMA take advantage of your expertise?
Right now, I’m responsible for developing and driving our overall strategy in the digital health and digital medicine space. The next wave of technology is coming rapidly, and it will be an essential component of delivering value-based care—it will include things like mobile applications, mobile monitoring, telehealth and so on. Those technologies will make important contributions to our ability to deliver value-based care.
There’s a huge gap in our knowledge of what works and what doesn’t, and we want to make those tools accessible and useful for our patients as well as our physicians, in our efforts to engage and deliver the best quality care. Right now, mobile apps are the Wild West of healthcare, and the AMA is pursuing discussions about developing guidance so physicians and patients can make better decisions about the use of these tools. No one wants to repeat the mistakes of the past, and HIT in the past was not driven by physicians. We haven’t been engaged enough in the development of these tools. We don’t want to see that going forward in the development of these new digital technologies.
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