Dr. Vindell Washington will soon likely leave the Office of the National Coordinator Health Information Technology along with other appointees across the Obama administration.
So, Washington candidly provided a different take on interoperability than did his boss last week.
President Barack Obama said the fact that healthcare organizations weren't sharing more information was a big disappointment of the Affordable Care Act.
“I think interoperability is a journey,” Washington countered. “I think the president and many others were hopeful we'd be further along. But I think we've made real progress over time.”
When he leaves, Washington will have served 161 days, the shortest term of all six ONC leaders, after taking over last August from his predecessor, Dr. Karen DeSalvo, who had the longest tenure, 2 years and 7 months.
Washington also served as DeSalvo's principal national deputy starting in January 2016.
During Obama's tenure, the federal government provided nearly $35.6 billion to help providers buy electronic health records systems.
But federal law also mandated that these EHRs be able to share information across organizations, and federal standards were set to ensure that goal.
Obama blames the plethora of different EHR systems .
“People make money on keeping people's medical records — so making it easier for everyone to access medical records means that there's some folks who could lose business,” Obama said.
Still, electronic prescribing, also a federal mandate and most definitely a form of interoperability — most commonly between a prescribing physician's EHR and local pharmacies — has been a runaway success. Surescripts, the largest eRx network, moved 1.4 billion electronic prescriptions in 2015, up 300% from 2010.
That's thanks in no small measure to the ONC requiring EHRs used in the incentive payment program have baked-in, e-prescribing functionality and the CMS insisting that eRx be used by physicians as part of the program's meaningful use requirements.
Washington mentioned he'd met last week with Vice President Joe Biden, head of the administration's cancer Moon Shot initiative, and talked of progress made with several major vendors using application programming interfaces to facilitate medication reconciliation, a knotty problem for hospitals and office-based providers.
“I've come to realize, until you reach a high level of adoption, interoperability was just too much of a white board, white paper exercise,” Washington said. “Until there is information that you have that I want and need, some of it, it's too ethereal to have progress.”
There are also cultural barriers to information exchange, and those are perhaps the hardest to overcome. Washington recalls as a practicing physician sending patients to the hospital's records room in the basement where they could purchase paper copies of their records for $1 a page.
“It takes time to turn the cruise liner,” Washington said.
Washington said he's not met with President-elect Donald Trump, but if he does, he'd advise him that the ONC should stay true to its name.
“We're the most effective when we are running our certification program, which paints the lines on either side of the road, and coordinating the IT effort in the public and private sectors,” he said.
Dr. Jon White, the current deputy national coordinator at ONC, is Washington's designated interim replacement.