The subjects of health information blocking and interoperability and the post-meaningful use future were highlighted both by his presentation and in questions and comments following his formal presentation, when Michael McCoy, M.D. spoke Wednesday morning, June 24 at the annual AMDIS Physician-Computer Connection Symposium, being held this week at the Ojai Valley Inn and Spa in Ojai, California. Dr. McCoy also addressed some of the underlying issues, in an exclusive interview with HCI’s Editor-in-Chief, Mark Hagland, following his presentation Wednesday. McCoy is the chief health information officer in the Office of the National Coordinator for Health IT (ONC), which he joined in late January.
Michael McCoy, M.D.
Referring to the ONC’s current efforts to reverse what agency officials see as information-blocking on the part of some entities in healthcare, Dr. McCoy said firmly to his audience of about 250 CMIOs on Wednesday morning, “Where the public good differs from what your business plan is, I think we’re going to have some legislative or regulatory relief. So I can suggest that if your business practices are not in line with allowing data to move freely, you might want to reconsider that position.”
Immediately upon the conclusion of Dr. McCoy’s prepared remarks, Bill Bria, M.D., chairman of AMDIS (the Association of Medical Directors of Health Information Systems), speaking to McCoy, said, “When I heard about information-blocking action, my heart leapt for joy. How will that proceed?” he asked, referring to actions being taken by officials at ONC, the Centers for Medicare & Medicaid Services (CMS), and the Department of Health and Human Services (HHS).
In response to Bria’s question, McCoy said that, “Certainly, this was not only a response to the senators on the HELP Committee who were concerned about anecdotes around challenges in getting data to flow and extremely exhorbitant connection fees to HIEs[health information exchanges] from vendor X, Y, and Z,” but also a broader response to actions on the part of vendors, hospitals, and other entities in healthcare. The challenges involved in trying to combat information-blocking are multiple, McCoy said. “It’s not within our authority to say, ‘That’s too much for that connection fee,”” he said. “Intellectually, if you have an old [information] system, and it requires a lot of entities to maintain it, because of the actual manpower, the cost to the vendor or developer is significant different” than with more up-to-date infrastructure, he noted. Still, he said, “What matters to me is that there are a number of hospitals and other organizations for whom it has been the business practice to not make connectivity easier.”
And, McCoy added, “Back to the public good: the public good is having data available to take care of a patient wherever they’re seen in your community. And it’s not ONC’s mission to make your business mission. But data liquidity is key to get interoperability moving. And I know that developers feel they have a lot of intellectual property built up, but if you’re looking at continuity of care, having [exhorbitant fees and other barriers to connectivity] is not good for the community. Having data move freely is important.”
McCoy also spoke to issues around data security in healthcare, and referred to the post-meaningful use future, emphasizing that ONC officials want the agency to continue to help to actively encourage providers and other stakeholder groups in healthcare forward towards greater interoperability, patient- and community-centeredness, and improved value, going forward into the future, years after the meaningful use program fully sunsets.
Shortly after his presentation, Dr. McCoy sat down with HCI’s Hagland and offered additional comments. Asked whether stakeholders in the healthcare industry have been hearing correctly the statements being made by ONC officials around information-blocking, he said, “I think some are hearing them correctly. I think some need to hear them a bit better. Per data liquidity, in some cases, the data is frozen and we need to apply some ‘heat’ to ‘unfreeze’ it. So applying the right heat from the right source will hopefully get that data unfrozen and moving freely. Sometimes,” he added, you just have to unblock one piece of ice, and the data starts flowing behind it.”
McCoy further clarified that he holds both vendors and providers, primarily hospitals and health systems, responsible for various types of information-blocking. “There are practices that end up blocking data because it is in one’s business interest to do so,” he said. “To be precise, they’re not so much blocking data as making data flow through a star. If you make a state-run HIE do a query every single time for every patient, that’s not illegal, but to me, that’s contrary to the public good. And that’s a hospital issue, not a vendor issue. And that’s just not the right way to approach it. So it’s not a full impaction, it’s a sluggishness that makes it unnecessarily hard to move data, and from a policy standpoint, it’s just wrong.” So to be clear, he said, “It’s more than just the cost of an interface, or the vendor not architecting things correctly.” Information-blocking “can also come out of local market competition.”
Three CMIOs receive annual “AMDIS Award”
(l. to r.:) Howard Landa, M.D., Bill Bria, M.D., Kevin McEnery, M.D.,
Howard Stutman, M.D., Christopher A. Longhurst, M.D.
Following the first presentations of the morning, Bill Bria, M.D., AMDIS's chairman, and Howard Landa, M.D., CMIO at Alameda Health System, Oakland, Calif., and a member of the AMDIS board, presented three medical informaticists with the annual “AMDIS Award,” for achievement in medical informatics. The three winners this year were Christopher A. Longhurst, M.D., CMIO at Stanford Children’s Health (formerly Lucile Packard Children’s Hospital, Palo Alto, Calif.); Kevin W. McEnery, M.D., director of innovation in imaging informatics at the University of Texas M.D. Anderson Cancer Center (Houston); and Harris R. Stutman, M.D., executive director, clinical informatics, and CMIO, at Memorialcare in Huntington, Beach, Calif. Bria noted that Longhurst is an educator of clinical informatics fellows, as well as an innovator in applied medical informatics, including the “green button” concept, that facilitates the aggregation of data from the electronic health record to guide medical decision-making when published evidence is not yet available. He noted that Dr. McEnery has been a leader in the radiology informatics field and a member of the AMDIS Advisory Council. And he said that Dr. Stutman is “well known nationally on EMR adoption, ongoing use, and content administration,” and has been heavily involved with AMDIS since its inception.
According to AMDIS officials, this was the 24th Physician-Computer Connection Symposium, at the 18th held at the Ojai Valley Inn and Spa. Ojai is located in the mountains of Southern California, and is very near to Los Padres National Forest and the Lake Casitas Recreation Area.