Speaking to an audience of about 240 CMIOs and other medical informaticists, Jacob Reider, M.D., chief medical officer in the Office of the National Coordinator for Health Information Technology (ONC), urged his audience on June 18 to focus on the bigger picture going forward, and assured them that his agency was doing so. Reider’s was the first presentation at the annual AMDIS Physician-Computer Connection Symposium, being held at the Ojai Valley Inn and Spa in Ojai, California, and sponsored by the Association of Medical Directors of Information Systems (AMDIS), the main CMIO professional association in the U.S.
Jacob Reider, M.D. at AMDIS
Quickly skipping past any details around Stages 2 and 3 of meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, except to confirm that ONC staff are working hard to get a proposed Stage 3 rule published this autumn, Reider urged his audience to think more broadly about where healthcare IT is headed in the coming years, while essentially saying that the fundamental principles of the meaningful use process going into Stage 3 are pretty much set.
Instead, Reider told the CMIOs that where ONC is head in the future is towards enabling continuous clinical and overall performance improvement in healthcare delivery among providers. “We’d like to shift towards measurement and improvement and away from measures and standards,” Reider said. “We’d like you to be capable of measuring the quality of care in your organizations, and improving the quality of care. And so we’d like to support you in improving the quality of care in your organizations, rather than focusing on the reporting of specific clinical quality measures. This will take some time to create the shift. As I like to say, giving all the kids in class a c-minus doesn’t help them improve” their academic performance. Instead, the focus will be on enabling and supporting patient care organizations and clinicians as they move forward into the emerging healthcare system of accountability, transparency, and value-based purchasing.
Reider spent some time in his speech discussing the three-year, six-year, and ten-year plans of ONC, noting that as a federal agency, ONC is required to produce and publish such plans. With regard to its three-year agenda, he focused on the goals of sending, receiving, finding, and use health information to improve healthcare quality. The language of the agency’s three-year plan includes the following: “Ensure that individuals and care providers can send, receive, find, and use a basic set of essential health information. This requires the ability to appropriately search for and retrieve health information, in addition to point-to-point information sharing. Address critical issues such as data provenance, data quality/reliability, and patient matching. Enhance trust by addressing key privacy, security, and business policy and practice challenges to advance secure, authorized health information exchange across existing networks.”
With regard to the agency’s six-year plan, he noted that the key statement for ONC will be “Use information to improve healthcare quality and lower cost.” And in terms of the ten-year agenda, he said the focus will be “the learning health system.” That includes the following language he shared with his audience: “Standardized data collection, sharing, and aggregation for patient-centered outcomes research. Clinical decision support that is widely available to all stakeholders. Clinical trials, public health surveillance, and evidence available at the point of care.”
Afterwards, Reider spoke exclusively with Healthcare Informatics. Asked what CMIOs can do to help their organizations transition into becoming learning organizations, he said, “CMIOs are experts in people, products, and process. And one of the key things they can do is to use their knowledge and understanding to help their colleagues in patient care organizations understand how important it is to go beyond simply purchasing and plugging in products, but instead to think carefully about the people and processes needed to make implementations successful in the long term.”
At one point late in his presentation, Reider lightened the mood by referencing a book that he said he and his wife read and used when they had small children: How To Talk So Kids Will Listen & Listen So Kids Will Talk, by Adele Faber and Elaine Mazlish. “Everything in this book about talking with young children applies to talking with your docs,” he said, to audience laughter. He read the following brief passage from the book: “When kids feel rights, they’ll behave right. How do we help them feel right? By accepting their feelings. Parents often say, you’re just saying that because you’re tired! Steady denial of feelings can enrage kids, and also teach kids not to trust their feelings.” Reider urged CMIOs to read that book and apply its principles to affirming the emotions of the physicians in their organizations, as they struggle forward to help their doctors move forward on automation, performance improvement, and other fronts.