Exit interview

Editor's note: Dr. David Blumenthal stepped down last week as head of the Office of the National Coordinator for Health Information Technology at HHS to return to academia. His replacement, Dr. Farzad Mostashari, started April 8. Blumenthal reflected on the job in an interview last week with Modern Healthcare reporter Joseph Conn. Below is an edited transcript of that exclusive podcast interview. You can listen to the interview in its entirety at ModernHealthcare.com/podcasts. You can also watch a video interview with Mostashari at Modern Healthcare.com/videos.

Joseph Conn: If you had to compile Dr. David Blumenthal's top three greatest hits at ONC, what would they be?

David Blumenthal: I think first of all I would start with the creating a transparent culture, a culture in which the work of the office and the policy development of the office is clear to the outside world and one in which we create the appearance of listening and thinking out loud with our colleagues throughout the healthcare IT community.

The second would be getting launched a whole series of infrastructure support programs, the regional extension set of programs on health information exchange, grants to states, our training programs, our beacon community programs. And I guess the third would be the work we did with our CMS colleagues to put in place the first stage of meaningful use, not necessarily as the final articulation of that concept but as the first step on the escalator toward more and more refined, sophisticated, beneficial versions of the meaningful-use regulation.

Conn: Is there anything that you wish you could have accomplished or started or got further along with but didn't because your time was up at ONC?

Blumenthal: I hope my departure from ONC will not be the end of my participation in this work, but I would say that the thing that I wish we had made more progress on and know we will make more progress on in the short term is creating interoperability and the capacity for exchanging health information in our healthcare system.

In that vein, the launching of what we call the Nationwide Health Information Network Direct Project is an important step forward, and this is a project that we hope will make exchange of health information using secure Internet e-mail-type communication an easy, simple and readily available exchange solution for the healthcare system as a whole. I think that's an important first step, but we have to do much better than that, and it's a very big challenge, one that presupposes information in digital form. The first step toward exchange is getting information digitized, so you have to start with adoption. But as you move forward with adoption, keeping interoperability in mind is very important, and I think we have done that, but we need to work even harder at it.

Conn: Do you have any estimate of how many air miles you have accumulated over the last two years and how many states or towns you visited for the first time while you have been traveling for ONC?

Blumenthal: I have been to at least 20 odd states and many communities. I really found it incredibly useful to visit each of those communities and to see electronic health records and physicians and hospitals in action trying to use information better and make patient care better. But one of the most thought-provoking visits I had was not in this country, but when I went to the United Kingdom to look at how England was managing its electronic health-record system.

I visited a small general practice outside of London, and they had reached 100% of their quality goals, over 100 specific quality goals that are part of their contract with the National Health Service. And it was clear to me that they had been able to do that in large part because they had an electronic health record. It was emblematic of what will be possible once we in the U.S. have reached the same level of penetration of electronic health records as some of our neighbors in other industrialized countries.

Conn: St. John of the Cross wrote about the Dark Night of the Soul, the battle between spiritual faith and doubt. Have you had a darkest night?

Blumenthal: I would say that the time of greatest concern that I had was at the time that we published the first version of meaningful-use—the final regulation—and I was concerned about whether we had reached the right balance between stretching the provider community and being realistic about what they could accomplish. We wanted to stretch them, but not break them.

Conn: You came from academia, the director of Harvard Medical School's Institute for Health Policy. Is that where you'll return to? And if so, what line of research will you be getting into in the next year or two?

Blumenthal: Once I leave, it will be a lot easier to discuss those things, especially since some of them involve not just Harvard Medical School, but its affiliated hospitals. I do think that I'll be trying to look for things that continue to stretch me. I spent 20 years doing research in the medical school and university, and they were very fulfilling years, and I expect that that kind of work will continue to be part of my professional life. I'm also at least open to the idea of doing other things, but what they might be I think only the future will tell.