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  Today in Health it, the story is seven national coordinators came on stage together at the CHIME forum and they were interviewed by Aaron Mi and I'm gonna talk about that in as much detail as I can. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT I channel dedicated to keeping Health IT staff current.

And engage no sponsor message for today so we can get through as much content as possible. Today's story, seven. Former national coordinators for health IT covering four administrations. Interviewed by Aaron Mary of UT Health and Dell Medical School. Uh, Mickey tpa with the Biden administration. Don Rucker with Trump administration.

ell, Washington Obama administration. Karen DeSalvo, Obama Farzad, Cheri Obama administration. David Blumenthal, Obama administration. Rob Linner, Bush administration. All right, so you had that group and I thought there was a lot of really interesting exchanges. I I'm gonna encourage you, if you haven't, go ahead and sign up for Chime.

You could download the uh, on demand. Content that is available from the conference. Even if you didn't get a chance to go, this one's worth listening to. I'm gonna give you some excerpts, but clearly I'm not gonna capture everything. It was an hour and it was very dense. There was a lot of really good discussions and conversations.

These are very serious, smart people sharing their opinions on where things have been and where they are going. And I think these are important voices to take into consideration. This is a long one, about 17 minutes. So you can put it on one and a half time speed or maybe listen to it over the weekend.

So the first question coming out of the shoot was about what did you get right as national coordinator and what would you have done differently? And I thought this was interesting 'cause he started with Rob Linner from the Bush administration and who was the first national coordinator for ONC around health it.

And. He said it was a, a, an an executive order at that point, and in order to make this a role that was gonna go from one administration to the next, he had to jump through a bunch of hoops to make sure that got done. And he did that. So he did the first health IT plan that went up. He also did a lot of the work across the various entities within the federal government.

To get established within HHS and just that conversation was interesting to hear how the government works and all the people and all the, uh, interactions he had to go through to establish this role as a primary role within HHS. The next question he tossed to Mickey Tripathy and said, what's different in the role than what you expected?

And Mickey just followed on with that and said, federal coordination is just a huge part and a bigger role than he anticipated coming into the role. And he didn't fully appreciate it from the outside. So there are a lot of agencies, there's a lot of coordination within those agencies that has to go on.

And one of the things that Mickey talked about is everyone has now realized that the EHR data is out there and it's fire enabled, and a lot of these other entities within the federal government are saying, Hey, can we use that data in some way? He went on to . Direct the next question around 21st century cures and information blocking, and Karen DeSalvo kicked this one off.

What she does is she sets us up by saying, look, the world has changed. We've gone to platforms, we've gone to interoperability through APIs. The internet economy has changed the way we are doing things from even when this role was initiated and from when we started rolling out the EHRs and we needed to update the way we looked at this, and I'm just gonna go ahead and read some of the things that she said.

We worked with the administration to propose some legislation that was taken up in the 21st Century Cures. That would allow us to have a more modern approach, basically, and to not only governing interoperability, but to achieving interoperability with an API fire based system and then addressing this really increasingly important challenge of data blocking.

So how could we unlock the data? That was locked down in silos. What would the carrots and sticks be and what could be used by HHS and others to see that people were not trapped in the EHR system and that data was not trapped in the EHR system and create a more fluid environment. That data can be shared not only between health systems, but with consumers as a critical part of the ecosystem.

And I thought that was a, a really interesting setup to understand . What, where the mind of the people that were helping to author the legislation, where they were going. And by the way, that didn't change with the Trump administration. So Don Rucker then came on after that and said, healthcare has got to move into a modern way of dealing with data.

And I think the old ultimate test of that is the ability for patients to have actionable data. So it's not just, is it available? As it was a couple years ago to them. But what they're trying to build on and actually do is give the patients data so that they can have agency, agency on their data, which they believe is gonna be transformative in healthcare.

And by the way, this was echoed across all of them. I say this often that the 21st Century Cures was bipartisan legislation, but if you were to listen to these seven people, they are . Almost in lockstep with regard to interoperability and data and the use of data and how it is going to transform healthcare.

I. And that is one of my big takeaways. It's always one of my big takeaways when all these people to get together. Karen DeSalvo came back and she said, I, I think it's also important for the audience to understand that the theme here is that we build on each other's work, and we try to do that in a very non-partisan way because that gives the industry a lot more certainty about where the future is going to go.

Okay, so again, she drives that home. This is collectively where 21st Century Cures is taking the industry. He then turns the conversation to Farzad, Moari and Dr. Blumenthal. To discuss what would they have done differently knowing what they know today, essentially. And David Blumenthal was the first one to answer.

And he said one of the things that we need to understand constantly is that the implementation and use of electronic health records and all the applications that build on them is fundamentally a human activity. And that if we don't motivate the users of those technologies to make the most of them.

they won't. And I think that's an acknowledgement by Dr. Blumenthal that they made some mistakes with regard to meaningful use, and they've learned from those mistakes. The role is a listening role, and they go into that a little further in the conversation, but he goes on to say, putting the software in place was no guarantee of the functionality for productive human purposes.

And he goes on to say, do I wish we had been able to wire interoperability into the initial implementation? And he said absolutely. But it took frustration with the lack of data exchange to create the political opportunity. That Karen DeSalvo and Don Rucker were able to walk through. So you get the picture, it takes time, it takes that political opportunity being created, and we then move on to the next phase.

And the next phase that we are in right now is 21st Century Cures and information blocking Far Side goes on to say, I think on the plus side, we created a sense. Of inevitability that this is going to happen. The medical record is going to happen, and so the fact that 90% of hospitals or more are on the EHR gives the foundation for all these things to move forward.

Aaron then turns the conversation back to Dr. Washington and Mickey Tripathy to talk about how the pandemic and how the Zika virus, how those things were impacted by the interoperability that was put in place. And Dr. Washington said, I remember one of the early sessions around Zika, we convened groups to talk about how to make sure that the moment the discovery was made, or information that was collected by the CDC, it could be pushed pretty close to the front lines to the daily providers.

Even things like what countries were affected at any point. So the idea of saying, tomorrow the CDC can find out that a geography was at high risk, and by that weekend, every physician. Would open their EMR and see that information. So that's the promise of what was there. Now, clearly we aren't there, and Mickey goes on to talk about some of those things and he just says, we have this siloing that exists between provider data and public health data.

And the public health systems have not been funded. So they've been underfunded. We know they've been underfunded. And so one of the things that happened during the pandemic is we took these provider systems, which we had invested billions, tens of billions of dollars in. We turned them on the public health system, which were inadequate to receive the data, and it was like turning a fire hose on a cup and they couldn't handle that.

And so we had all sorts of things that fell by the wayside. Now with that being said. What happened was a lot of CIOs and a lot of people who listened to the show took advantage of the interoperability that was put in place. They started to stand some things up and they were able to share information across institutions and with public health entities that was able to help us get through this public health emergency.

And it's really interesting 'cause it goes on to say that now the role is to institutionalize all of that work that has been done. Farzad builds on that and he says, yes. We did have some shortcomings and we did have some problems, but compared to 10 years ago, just the availability of the electronic lab reporting to public health, the syndromic surveillance reporting, and even the vaccine immunization registries, and a lot of these features were not even available or weren't out there.

So we are in a much better place today than we were 10 years ago, and the expectation is that we will continue this progress over the next 10 years. Aaron then addresses Dr. Washington. And he asks about the way that we provide feedback with the ONC. and he says, so this is a softball question. It's interesting.

It is a softball question, but every single one of them chime in on it. They want you to know how important it is to provide feedback, and Dr. Washington talks about the importance of those listening sessions, and he has become an evangelist on this. The department is really interested in hearing feedback.

From folks when the rulemaking process is going on. Mickey Repath then jumps in and says, my email address is Mickey repath@hhs.gov, which tells you they can't do this role without you. They need you to provide feedback. Dr. Moari then leans in and says, only one thing to add on this. To the CIOs out there is that the AstroTurf doesn't work.

And what he was talking about is when the vendor sends you a form letter and says, Hey, can you sign onto this? He said, I, I'll just tell you right now, it counts as one. If a hundred of you sign onto it, it's still one idea, one concept, and they put it down as one. So what they want you to do is they want you to be specific, granular, talk about your experience, be grounded in your reality, and don't just sign on to some form letter.

Okay. So that was his feedback. And Don Rucker goes on to talk about the need to hear the voice of the people, right? The individual patients, the people who don't know what HHS is. The people that don't know what ONC is, the people who are out there that are in rural communities, the people that are in underserved communities that aren't going to be a part of the

Rulemaking process. We need to figure out a way to get their voice to be heard. And then Karen DeSalvo comes back and really ties us all up really well with her comments. And she said David and Farzad really were thinking about it with respect to equity early on in the journey that they had with meaningful use, wanting to ensure that, for example, rural America had access.

In the way that an urban environment would, but also thinking about the importance of vulnerable populations and access through venues like community health centers. So it's always been a part of the charge of the work that they do. I think on the other hand, it's quite difficult to do, and I call out to Mickey.

As you're thinking about public health, as you work on data and modernization with the CDC, it's going all going to be a similar challenge. You'll have the squeaky wheels are able to come forward and share their points of view and opinion, but there are a lot of very small health departments that have less opportunity, less bandwidth, less understanding of the health ecosystem you have to build for that.

Mickey. Then chimes on to that and says, look, I want you to know that every single comic gets logged. It gets talked about. It gets gone through. So in the next question, Aaron goes into, we have all this data coming in, and what's that going to lead to? What is the possibility here? And Farzad says, I think I was too partisan.

Not partisan politically, but partisan when it came to EHR data versus claims and the power of payer claims. It's just mind blowing. What we're doing now, integrating both the the provider and the payer claims, every single thing that got paid for by the patient across every single part of healthcare.

And then comparing that across the narrow slice of the information that is reflected in the EHR, which is only a fraction of that, then supplementing it with pharmacy data, medication history, and so forth, really gives you an incredibly powerful view of the patient. And we talk about this often, which is the whole patient profile.

It's seeing the whole patient and he's, he goes on to say, I think one of the leading EHR vendors told us that they had spent half of their development hours understanding the quality measurement numerators and denominators in their first year of meaningful use. And I think the jump I. To then say, expecting these same EHR vendors who are so focused on clinical workflow and clinical documentation, and frankly on clinical billing, to now be able to understand the context of population health and the concept of who's not in the office today as opposed to who is in the office today.

I don't think we can rely on the same vendors to do both, and so the approach that people are now making sure parties can access and batch that data, those records and those APIs. I think it is the right approach, and there will be many applications on top of that that aren't going to be based necessarily on the EHR.

All right? So by the way, it would be one thing if one person was getting up there and saying something completely different. They're not. They're in complete agreement that there is going to be an ecosystem that's created, a platform that is created where this information starts to move in and out of the various EHRs and gets used for the benefit of the patient.

Aaron goes on to ask, what's the future look like with all this data flowing around Del Washington says, I think one of the things that we're coming to the realization and across healthcare is that really the digital phenotype, that sort of collection of information about the individual is one of the things that determines what the right next thing is for an individual.

We're not just individuals across the country that have diabetes or hypertension. We're real people. Whether or not I have insecurity in my housing or food insecurity or other elements, these might just be as important as what's in the EHR. So when I think about what's the future, what's next on the horizon, it's where are those other data sources, whether they're provided by the individual or just data that's available on

Human services across the country. How do we put that into a usable format? How do we put that in the hands of the people that can turn the knob? That's the way you're going to improve the care of people more broadly. It's not by ignoring those data sets, but by figuring out ways to pull those into the mix, into the data warehouse, into the AI machine learning engines, and figure out what the next steps are for that individual.

Absolutely great comments, great perspective on things. David Blumenthal points out that the payment systems don't align with this, and he's worried that we are gonna have great technologies that can't get paid for because our payment models are so fragmented and in their terms messed up. Don Rucker then jumps on that point pretty significantly.

Uh, Karen DeSalvo then wraps it up. And says it's even more complicated than that. First of all, there will be a lot of discussion, I suspect, in the next few weeks or months about whether we're going to be moving more towards value-based care, downside risk, or we're going to give it up and just go back to fee for service.

So that's a separate conversation, which does interfere with. Is there a business model aligned with interoperability, but there's also the opportunity cost of not having interoperability, and we've just felt that very acutely in the pandemic, not only within the healthcare system, but between the healthcare system and public health and social care.

So I hope we don't forget that too quickly, and that continues to be, I'll just say a moral imperative. Aaron closes out the conversation and gives each of them an opportunity to say, what would you say to the frontline workers? And for the most part, they say, thank you. Thank you very much for the work that you've done.

It is greatly appreciated by them and the people of our country. There you have it. What's the So what I try to do a so what with each one of these stories, there's no reason to do one with this one. There's so much there for us to walk away from. I don't want to add to it. If you know of someone that might benefit from our channel, please forward them a note.

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