Vindell Washington, MD, the newly appointed National Coordinator for Health Information Technology, might be on the job for just a few more months—his service officially ends on Jan. 20, 2017—but he’s determined to ensure that ONC’s health IT initiatives have a positive, lasting legacy.
At a media briefing on Monday, Washington told reporters that his priority as National Coordinator for Health IT is to continue to implement ONC’s Nationwide Interoperability Roadmap as part of the Department of Health and Human Service’s delivery system reform initiative. The public-private roadmap seeks to enable the healthcare industry’s transition from fee-for-service to a value-based payment through the use of interoperable HIT, he said.
“I believe that the work we’re doing on information sharing is actually foundational work for a number of the Administration’s priorities. I think it’s important for delivery system reform, and I think it’s particularly important for the Precision Medicine Initiative and the Cancer Moonshot,” said Washington, who joined ONC in January as principal deputy to National Coordinator Karen DeSalvo, MD, and replaced her in August.
“Even though those are large and longer-term strategies, the work that we have to do in the short term is increasing the flow of information and empowering patients in this space to have their information and be able to use it and send it forward for the purposes that they choose,” he added.
According to Washington, there is a misconception in the healthcare industry that HIPAA is a barrier to the movement of electronic health data when and where it is needed for patient care. As a result, some healthcare providers are not sharing protected health information. To address this problem, he said ONC and the HHS Office for Civil Rights issued guidance in February “clarifying the rules around HIPAA” on permitted uses and disclosures for both exchange for healthcare operations and exchange for treatment.
“There’s been some resistance to information flow because folks don’t understand the rules as much as they should,” he added. “Getting that word out and pushing that forward in these last few months is particularly important.”
While the nationwide adoption of electronic health records is nearly universal, especially among hospitals, the industry still suffers from a lack of interoperability between these systems, acknowledged Washington. In that vein, ONC reported that in 2015 only about half of hospitals routinely have electronic access to necessary clinical information from outside providers when treating a patient.
ONC recently released for public comment its draft 2017 Interoperability Standards Advisory, a catalog of standards and implementation specifications designed to be used by industry as a single list to meet interoperability needs focused on clinical health IT.
“The specificity of standards is necessary for passing information,” asserted Washington. However, he argued that “working toward cultural changes around the sharing of information” is just as important as technology and standards in fostering interoperability. “Quite frankly, in a lot of instances, you’re asking providers to look at their own best financial interests to really share information.”
When it comes to health IT, an AMA-funded study released earlier this month found that physicians are spending more of their time struggling with burdensome electronic health records than they are providing direct patient care. However, Washington responded that EHR technologies will evolve and documentation will improve over time.
“We’ve been documenting for a while—that‘s true, but we’ve not always documented well,” he said, referring to the study which found that for every hour physicians provided direct clinical face time to patients, nearly two additional hours were spent on EHRs and other clerical work, while doctors spent another one to two hours of personal time each night doing additional clerical work, mostly related to EHRs.
As former president and chief medical officer of Baton Rouge, La.-based Franciscan Missionaries of Our Lady Health System Medical Group, Washington said he knows firsthand that “there are pockets where people are doing very well and pockets where people have time that they spend at home documenting.”
Overall, he commented that “it’s a sort of mixed picture” that will continue to evolve as practicing physicians gain greater efficiency in performing EHR documentation as both vendors and providers innovate.
“At the end of the day, change is hard,” Washington concluded. “But, I really don’t know anybody who would like to go back to paper” records.
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