January 20 will be Vindell Washington’s last day on the job as National Coordinator for Health Information Technology. Although he has been at the helm of ONC for less than six months, Washington is leaving the agency and government service with a strong sense of accomplishment.
Washington, a physician who is board certified in emergency medicine, sees the “signature achievements” during his tenure at ONC as being those that supported the Obama administration’s “capstone initiatives,” including delivery system reform, precision medicine and the Cancer Moonshot.
“Most of that work has been done in the area of interoperability,” says Washington, who joined ONC in January 2016 as principal deputy to then-National Coordinator for Health IT Karen DeSalvo; he replaced her in August.
Health data sharing is critical to supporting these high-profile initiatives, he contends, as well as to fulfilling the Triple Aim in healthcare. When it comes to interoperability, Washington makes the case that ONC’s positive and lasting legacy can be divided into three categories: changing the business model for health information exchange, as well as the culture of HIE, and supporting the healthcare industry’s transition from fee-for-service to value-based payment through the use of HIT standards that support interoperability.
In particular, he says Health Level Seven International’s Fast Healthcare Interoperability Resources (FHIR) application programming interface (API) is moving closer to becoming a mature standard. Last month, as part of an initiative led by ONC, a live proof-of-concept demonstrated medication list functionality with electronic health records using a FHIR-based app.
In the live demo at the Connected Health Conference in Washington, data from Allscripts, Cerner and Epic—three of the largest EHR vendors—were successfully integrated into an app from medication management vendor Medisafe using FHIR, enabling patients to pull a consolidated list of their medications from different locations, such as hospitals, physician offices and clinics.
Washington calls last month’s FHIR-enabled demo of how patients can access medication data easily and safely across different EHRs a significant milestone in HIT interoperability. “I think there is great potential in FHIR.” At the same time, he acknowledges that despite progress, “there is still work to be done.”
While FHIR builds a base set of resources that satisfy the majority of use cases, Washington notes that despite the ability to “pass certain bits of information using the FHIR API among vendor participants” in last month’s consolidated medication list app demo, there was not enough detail in the FHIR protocol to accomplish the task at hand.
“In part, what’s necessary for the resources to be more fully developed is for the use cases to both emerge and be exploited among vendors and data holders in the ecosystem to work out the last I-dot or T-cross in the actual standard,” he adds. “Use cases will push FHIR further.”
In the end, Washington sees FHIR as a robust, emerging interoperability standard with the most capabilities and potential to be widely implemented in healthcare. “That’s not to say that I believe that FHIR will be the last transfer protocol we will ever have,” he says.
Washington is encouraged by public-private partnerships such as HL7’s Argonaut-FHIR Project, CommonWell and The Sequoia Project, which are focused on advancing implementation of secure, interoperable nationwide health information exchange. “Public-private partnerships tend to be particularly durable,” he adds.
In addition, Washington believes that the push for interoperability has reached a new level of urgency, particularly with the inclusion of new requirements in the 21st Century Cures Act that was recently passed by Congress and signed into law by President Obama.
The 21st Century Cures Act “was one of those efforts that was really widely supported,” and ONC “worked particularly closely with Senator Alexander and Senator Cassidy” on the legislation, according to Washington. He says the law “puts up some guardrails and has some penalties attached for folks who are bad actors.”
Asked about the problem of health information blocking, Washington concedes that it is “hard to quantify in terms of scale.” However, at the same time, he believes that information blocking exists, referring to a 2015 ONC report to Congress that concluded that some vendors and providers have created technical, legal and business barriers between their EHR systems and other systems to interfere with access to health information.
At the HMISS16 conference in March, ONC helped to broker a commitment—in the form of voluntary pledge—from major EHR vendors, providers and industry groups to not block electronic health information, one of three commitments they made to improve HIT interoperability.
With the transition from the Obama administration to the Trump administration, Washington says he expects ONC will continue its mission as a HIT coordinator and facilitator. “I’m very excited about the future of ONC,” he concludes. “We have some very capable career service folks that are in place. They know the space well, and they’ve been engaged in many of these public-private partnerships.”
Washington did not provide details on his future plans after leaving ONC later this month. “I’m not completely certain what I’ll be doing when I leave this role,” he adds.
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