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Live From AMIA: Reider Leads ONC Town Hall

November 18, 2013
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Other federal grant-making agencies will take advantage of MU progress, ONC staffers say

For healthcare informatics junkies, the annual AMIA Symposium in Washington, D.C., is the place to be. It’s the meeting where young informaticists get inspired to devote their careers to applying technology to improving the healthcare system. But don’t take my word for it. Kicking off an ONC Town Hall meeting on Nov. 18, Jacob Reider, M.D., the acting national coordinator for health IT, recalled how 24 years ago he gave a paper at the AMIA symposium, which really started him on a career path of applying technology to take better care of patients.

Unlike his predecessor, Farzad Mostashari, M.D., Reider doesn’t give inspirational speeches and describes his interim role as being more of a facilitator. Although like Mostashari, he did mention a personal experience that focused his attention on the real human impact of his work. Four days into his tenure as interim national coordinator, Reider joined his mother in an ambulance ride to an emergency room. “It is sobering to be in that position and watch health IT work well, which I witnessed, and not work well, which I also witnessed.”

During the Town Hall, he brought a team of ONC executives to answer questions from the audience.  The very first audience question was: Does ONC have the authority to delay Stage 2 of meaningful use and what are the chances it will do so? ONC’s Jodi Daniel responded by saying that ONC is focused on implementation of Stage 2. “We have heard from stakeholders about concerns, and we are looking at timelines. I don’t have magic dice to talk about chances of anything,” she said.  She added that any change would be up to CMS, not ONC, and for CMS to change the timeline would require a regulatory change.

Another audience member asked what kind of funding for research and development would be available once the HITECH Act funding expires. ONC’s Doug Fridsma noted that ONC existed before HITECH and will exist after. He also noted that as ONC grants sunset, other grant-making organizations, such as the National Science Foundation and the National Library of Medicine can build on those efforts, such as the Sharp projects. “ONC can be an influencer of federal partners to align their efforts and leverage meaningful use even though we are not funding them directly,” Fridsma said.

Besides the ONC Town Hall, I saw several other great panels Monday. One was a debate about whether AMIA should once again advocate for a unique health identifier for care and research purposes and if so, what kind of standard should it support under what conditions? An audience poll following the debate seemed to suggest that a majority wanted AMIA to advocate a unique health identifier, but there was widespread recognition that political headwinds continue to make consensus on the right direction unlikely.

Another great panel dealt with the present and future of electronic clinical documentation. Panelists said providers identify many benefits from the shift to electronic clinical documentation, but problems persist. Many identify the loss of the patient story from the encounter and the increase in time they spend in front of the computer instead of with patients.

Thomas Payne, M.D., an associate professor in the Department of Medicine at the University of Washington and medical director of Information Technology Services for UW Medicine, quoted a recent study that found interns spend 40 percent of their time in front of computer screens and more time reviewing patient charts than directly engaging patients. “It seems to me that 40 percent is a little high,” he said. “It is an important issue for us to quantify and improve upon. What we learn the most from is human interaction. We have a lot of work yet to do. I don’t think we have hit this one out of the park yet. Our students are smart. I want them to have models for what we think is best about the delivery of care.”

I’ll have much more from AMIA this week, including a report on the Informatics Year in Review from Dr. Daniel Masys, affiliate professor in the Department of Medical Education and Biomedical Informatics at the University of Washington.