Micky Tripathi, Ph.D., the founding president and CEO of the Waltham-based Massachusetts eHealth Collaborative (MAeHC), has been active in healthcare industry thought leadership for many years, in a wide variety of areas, including strategic planning and consulting, policy advisement, and health information exchange (HIE) development, among others. Not long after Farzad Mostashari, M.D. announced that he would be stepping down this autumn from his position as National Coordinator for Health Information Technology, Tripathi sat down for a conversation with HCI Editor-in-Chief Mark Hagland, to offer his perspectives both on what might be next for the Office of the National Coordinator for Health IT (ONC) specifically, what the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act, and how the new healthcare—the healthcare system’s shift towards accountable care, population health, patient-centered medical homes, value-based purchasing, and the like—is shaping up at this critical moment in the history of the U.S. healthcare system. Below are excerpts from that interview.
Given the announcement of Dr. Mostashari’s imminent departure from ONC this fall, what might and should happen at ONC next, in your view?
Well, just to be clear, it’s not as though I have a deep inside track to information; but I do spend a lot of time with the advisory groups at the ONC. I think right now, from what I can see, is that what should happen probably will happen, for the most part. There are only two years left in the Obama administration, and even if a Democrat succeeds President Obama, there will most likely be turnover at the agency. Now, Farzad’s position is not a congressionally appointed position. But the political scenario probably narrows the field a bit. And the fact that the meaningful use train has left the station and is moving down the tracks, that fact suggests that you’d want someone pretty familiar with the meaningful use process, who can pick up the remainder of the Stage 2 work and pick up with Stage 3.
Does that mean you believe that Dr. Mostashari’s successor will or should be an ONC insider?
Yes, I’m going to suggest that it probably will be and should be an “insider,” but I would suggest that the concept of “insider” would encompass the HIT Policy Committee and Standards Committee, and others who advise those committees or might be a part of some of the other committees, or maybe the think tanks. There is an establishment of people who have been very involved in or have been close to this. Not to disparage anyone who’s not been a part of the process, and it’s always good to bring in good ideas, but I’m not sure that’s the task. Someone coming in will have to be able to pick up the process and guide it to completion. My personal thought is that it should also be a physician, not necessarily because physicians are more qualified than anyone, but in terms of the representation to the public.
And in terms of the advocacy part of the role, per physicians in practice in this country?
Yes, the sense that whoever’s in charge understands physicians’ concerns. I don’t think it necessarily translates into a difference in how they operate on the ground, but this is about change, and the physician industry is a craft industry of very bright people, but people who are trained institutionally and academically to think and act independently, and it takes a lot of advocacy to change that. And I can say that because both of my parents are physicians. And that’s partly what makes it so complex.
Does meaningful use feel on track to you right now as a process?
Within the environmental constraints that all of us face in the industry at large, I think it’s very much on track. But let me explain why I framed it that way. If you think conceptually about what meaningful use was supposed to do, it was supposed to first get people onto [clinical information] systems, and then get them to use those systems, and then get them to use those systems to be a vehicle for changing care outcomes. So it seems to me that if you look at the adoption numbers of electronic medical records, they’re phenomenal. And even the most cynical people have to look at that. And yes, there’s going to be churn of vendor selection and implementation. But I don’t think anyone can look at an industry like this one, especially such a guild-based industry as this one, and not concede that MU has been successful in terms of adoption.