On January 21, the Office of the National Coordinator for Health IT announced that Michael James McCoy, MD, would be the department’s Chief Health Information Officer, a newly created position. According to the announcement, Dr. McCoy will serve as the lead clinical subject matter expert on interoperability, and he has a background perfectly tailored to the task with experience both as a practicing physician and as a leader at the IHE for more than a decade.
Thanks to Dr. McCoy for answering the following questions about the new position and his vision for a learning health system.
Q. First, congratulations on the new appointment with the ONC. You previously practiced medicine and held various leadership positions in the private sector, what attracted you to working with the ONC and what vision do you hope to bring to the department as the industry moves into stage 3 of Meaningful Use?
ONC is at a crossroads, coming through a period where significant funding was applied to incentivize the adoption and use of basic electronic health information technology to one where the information can flow to help achieve better care, smarter spending of health care dollars, and healthier people. Now we need to make sure that the infrastructure we have established through the supports created in the HITECH Act can provide returns, with data and analytics capabilities that progress us, as a nation, toward a Learning Health System.
I had the good fortune to be in the right place at the right time to be able to join ONC and the great team of people here to further the goals of improving health, health care, and reducing costs of health care delivery with a person-centric view. Dr. Karen DeSalvo, the National Coordinator for Health IT – my boss – continues to be supportive about the importance of health information technology as the tool to support achieving better health (not as an end unto itself).
I hope that my experience as a practicing clinician with early EMR use in the office, as someone with vendor and implementation experiences, and with system-level knowledge of the challenges for adoption and utilization of the data available, can provide a balanced perspective across ONC. There are many offices within ONC that have huge impacts on policies, procedures, rules, and regulations – way more than I realized before joining the team here! There is significant coordination required between the various teams, and Dr. DeSalvo has been working to ensure the views are balanced with senior clinical and legal/legislative perspectives applied.
My vision is that I may be impactful in advancing the notion of person-centric health, and in some small way, help influence the direction that our advancement to a Learning Health System takes. I fully embrace a person-centric concept, and think announced initiatives, including Precision Medicine, will continue taking our nation’s health system down that path.
Q. Karen DeSalvo was quoted as saying you would serve as the ‘lead clinical subject matter expert on interoperability.’ This brings to mind the inclusion of patient-generated health data into the medical record. How do you think the big questions about responsibility for the PGHD (e.g., Is the physician legally responsible to monitor the data? Are patients responsible for accuracy of reported data? etc.) will be resolved?
The subject of patient-generated health data (PGHD) has many complexities, but in reality, some of the biggest questions relate to similar concerns expressed by clinicians in reviewing “data dumps” from Transitions of Care (TOC) documents, or receiving old records from other physicians. Those concerns relate to the (receiving) physician missing some critical data element in the old record (whether paper or electronic) and their liability as a result of missing that information. There have been lawsuits on this with paper records, and now with electronic records, there is even more data (potentially) for a clinician (or attorney) to review. Whether the data comes from another EHR or from PGHD, there is some obligation for the clinician to review the information received. To what extent and how much data validation must occur (the trust or provenance of the data source) are not yet defined clearly. The legal requirements, the ethical requirements, and the practical requirements for that “minimum level of review” have not been fully established, nor has a consensus view been achieved on what is “right.” ONC is certainly not, in my view, the arbiter of such, though it could, through outreach and coordination and/or through its advisory committees, convene such discussions.
To me, the concerns, about PGHD misses the bigger picture: individuals are now beginning to drive their own health care decisions in a big, and growing exponentially bigger, way. If physicians do not choose to engage with the increased consumer demands, they may find themselves increasingly marginalized in the care delivery system.
This presents opportunities for developers and other technically savvy entrepreneurs to look at the challenge of filtering signals from the noise. Everyone is busy these days; finding the important e-mail amongst all the other e-mails and spam received is a great thing. Physicians want the same thing from the PGHD received, and from all of the other interactions with their health information technology (rules and alerts that make sense). Usability, and good (actionable) information, not just data or noise.
Q. A person-centered health system seems to make perfect sense when it’s talked about at the water cooler, yet I sense there is a large chasm that exists between the goings ons in the health care system and the majority of patients in the U.S. How can we be sure that patients really want to be engaged with the health care system?
Not every “patient” wants to be engaged. That is the reality. Sometimes it is exactly those patients, though, that need to be engaged.
However, looking at the opportunity from a different perspective, the way to a better, healthier country is to engage people before they become patients. Witness the growth of wearable devices, connected to the Internet of Things. The FTC report forecasts 25 billion devices communicating over the network this year and 50 billion by 2020.
Further, assuming it is just a patient that wants to engage is another fallacy. Many of us have roles as caregivers, whether for spouses, children, or parents. Many of us live remotely from the person receiving care. Having access to be able to assist in understanding the care received, ensuring good communications with care providers, and being actively and proactively engaged is possible only through application of health information technology.
There are so many opportunities to improve the relationships between people (whether a patient, caregiver, or healthy individual) and clinicians (in hospital settings, offices, long-term care settings), and technology can help. Many physicians still seem to view patients coming in with externally garnered information (“Dr. Google”) as problematic, instead of as interested and engaged in their health.
The whole care delivery system is in the midst of transformation (even disruption), and embracing and adopting the change is a better approach than becoming obsolete.
Q. As a former board member, you obviously have a lot of interest in IHE’s activities. Where you surprised there was no mention or talk about IHE in the most recent JASON report? What role do you think IHE will play as HL7 FHIR progresses?
The November 2014 JASON report did not reference IHE, but I don’t find that too surprising given the constituency of the advising body. As in many other circumstances, one approach may be favored by those in office at one time and less so by subsequent office holders. IHE references and use was quite prominent in the HITSP days, less so until recently. One may note that in the 2015 Interoperability Standards Advisory draft, IHE is mentioned multiple times, with XDR, XDS, PIX/PDQ, XCA, XCPD, CSD, and HPD all called out.
There are many technically savvy people (aka “geeks”) that work in and with both HL7 and IHE, and harmonization and collaboration between the two groups can only help the overall advancement of health information technology. Perhaps in my simplistic (? naive ?) way, I view the constructs as HL7 and others (SNOMED, LOINC, RXNORM) providing the “ingredients” to IHE’s recipe (e.g., IHE PCC’s APS, LDS for obstetrics) on utilizing in a meaningful way the constituent parts. Much as a cake recipe calls for sugar, eggs, and flour as ingredients, the “how much sugar,” “how to mix,” “how long to bake and at what temperature,” etc. define the end product (the cake). Many different cake recipes exist, just as many different use cases for health data exists….
Q. What do you hope the health care system will look like in 5 years?
In 5 years, I hope we are well on our way to the Learning Health System, with little or no thought required to get my health data into or out of any part of the care delivery system I am interacting with. I want to be able to take my personally derived data (from exercise on my bicycle or from monitoring my weight with my WiFi-connected scale) and have it available for those with whom I wish to share. I want to be in a health care system that is focused on wellness and general health as much as it has been focused on episodic care and illness.
The draft Interoperability Roadmap (open to public comment until April 3rd) provides the proper vision towards a Learning Health System that will achieve those goals. It may be an aggressive timeline to some. It certainly is reflective that ONC cannot carry the burden alone. Public, private, state, and federal cooperation and collaboration is essential to achieving success. Our nation’s health depends on it. I think it is the most worthy goal one could have as a health care professional. I certainly am proud to be associated with the dedicated and brilliant team here at ONC working to achieve the goal!
Special thanks to Peter Ashkenaz and Brett Coughlin from the ONC for their help facilitating this post.
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