The role of national coordinator for health IT comes with its fair share of policy constraints and budget limitations, but partisanship is one of the few Capitol Hill hurdles the office has managed to avoid over the past decade and a half.
In a recent College of Healthcare Information Management Executives (CHIME) panel convening current National Coordinator Micky Tripathi, M.D., with six of his predecessors, the health IT leaders swapped stories about the challenges that came with guiding health IT policy through major periods of change.
Rob Kolodner, M.D., who held the role for two and a half years at the tail end of the George W. Bush administration, looked back fondly on his group’s work to develop the first federal health IT strategic plan. Doing so allowed the Office of the National Coordinator of Health IT (ONC) to keep its funding and persist from administration to administration, he said, although obtaining the necessary approvals forced his team to compromise on a familiar issue.
“We mourned the loss of one of the three goals we put in … that explicitly stated that patients should be able to reliably and securely exchange electronic health information with their providers and have access to their own personal health data,” he said. “That was a bridge too far at that time.”
A more recent regret came from Tripathi. Following the “tremendous investment” he and his predecessors made over the years to lay down a foundation for the nation’s digital medical records systems, Tripathi said watching the data flow challenges spurred by COVID-19 has been a punch to the gut.
“For years, we’ve been saying that public health is underfunded, public health is too fragmented, public health has too many jurisdictional issues—all of that, and we invested $40 billion in EHR systems that set a fire hose on the public health system with one-way flows of data that the public health system was not prepared to do anything with,” he said. “We saw that [the EHR infrastructure] fell down on the job in many ways, which was very disheartening, I think, for all of us.”
In contrast to their disappointments, the national coordinators repeatedly pointed to the office’s ability to work with future administrations and lawmakers on both sides of the aisle as a source of pride within the office.
For Karen DeSalvo, M.D., national coordinator under President Barack Obama between 2014 and 2016 and now an executive at Google Health, work on the 21st Century Cures Act was “a wonderful example” of the office communicating bipartisan IT needs, legislators understanding why ONC needed to take on new roles and subsequent teams at ONC continuing and adding onto those efforts down the road.
“The theme here is we build on each other’s work and we try to do that in a very nonpartisan way, because that gives the industry a lot more certainty about where the future’s going to go,” she said.
Vindell Washington, M.D., whose five-month run closed out the Obama administration’s time in office, agreed with DeSalvo.
He said the constant contact between his team and Republican Senator Lamar Alexander Jr.’s staff as they wrapped up the Cares Act was one of the biggest surprises of his tenure. Paired with that was the first time he met his successor, Donald Trump appointee Don Rucker, M.D., and the trust he had in the incoming coordinator to pursue what they both felt was best for the healthcare system’s future.
“We had philosophical discussions, but really as we moved to what was necessary in this space to help support healthcare more generally and the IT structure, I felt very much afterward watching what happened month after month, quarter after quarter, that it really was building toward the ability to support the nation in the way we both believed needed to be supported,” said Washington, who now works at Google sister company Verily Life Sciences.
“That kind of bipartisan push, and then a set of agendas that would allow us to respond to disasters and stressors on the system like Zika, like COVID, is one of the things I’m most proud of in terms of the service.”
The national coordinators stressed that they want that spirit of collaboration to extend into ONC’s relationship with industry—especially because it would be relatively easy for the office to turn into an echo chamber without letters and other feedback from the public to guide its decisions.
David Blumenthal, M.D., who served from 2009 to 2011, said the regulations written during his tenure “weren’t the products of government bureaucrats” but of feedback from his constituency.
However, he also noted that the industry tends to only make noise when it’s upset with a rule proposal. Stakeholders need to understand that feedback on what policies are appreciated can be just as important when drafting future rules, he said.
Tripathi took the call for comments a step forward by announcing his email address to the viewers ([email protected]) and inviting stakeholders to contact that account directly with their feedback.
He said the public would be surprised to learn how much sway their comments during listening sessions, forums and other feedback have on major rules and the patchwork of FAQs and updates that follow.
“Every single comment gets heard,” he said. “Sometimes you don’t see it in a direct response, but I can assure you—and that’s another thing I didn’t really appreciate from the outside—that it’s taken very, very seriously. Every single comment that comes in gets logged, gets wrestled over, compared with others to say ‘how does that compare with what else we’ve heard and how does that adjust our thinking?’”