B. Vindell Washington, MD, former National Coordinator for Health IT, believes various data strategies hold transformative potential in 2018.
Dr. Washington, who joined ONC in 2016 under the Obama administration, says the U.S. is in the midst of a "continuing evolution of health IT," tracing back to at least the 2009 passage of the Health Information Technology for Economic and Clinical Health Act.
The HITECH Act is often credited with spurring nationwide adoption of health IT systems, such as EHRs. In 2016, 99.1 percent of hospitals had partially or completely implemented an EHR system, up from 33.6 percent in 2003, according to a 2017 study published in the American Journal of Health-System Pharmacy.
Despite nearly ubiquitous EHR adoption in the hospital space, the work is just getting started. For Dr. Washington, the next step is applying patient data collected in EHRs to a range of purposes — from point-of-care clinical decision support to widespread population health management.
"That was really just step one, having the technology available to have care documented in a digital way," Dr. Washington explains. "But we don't stop at, 'Yes, people have these tools.' How do we make sure the environment is correct for further adoption, and for easing the use of these tools to reach the promised benefits of health IT?"
Becker's Hospital Review caught up with Dr. Washington — who now serves as CMO of Blue Cross and Blue Shield of Louisiana — to discuss the health IT trends he's keeping an eye on in 2018. Here are four excerpts from the discussion.
Editor's note: This interview has been edited for length and clarity.
1. On ensuring patients can access medical data: "Giving patients their data — for both their own management and for being more transparent about the information we have about folks — is a solution we haven't been able to do, in terms of aggregating patient charts and information across lots of different care settings," Dr. Washington says. "It will be important to provide patients with a synopsis that's both understandable and able to be used for lots of different purposes; giving them the opportunity to use their data for care delivery, to contribute to research or to be more informed about their health. CMS started some of this work with the Blue Button Initiative [a program that allows Medicare beneficiaries to download health records to share with their providers], but there's a lot of activity in the space that I'm particularly excited about."
2. On using big data to evaluate emerging technologies: "If we manage the digital flow of information correctly, the cost of research could be cheaper and the solutions could be more targeted," Dr. Washington says. "In the past, we've spent time looking at double-blind control studies, where you identify a subset of patients who look somewhat like the population you're interested in, but we never had the opportunity to analyze broad swaths of the population with digital data until now. How evidence is generated will become a real game-changer, particularly as we look at areas like precision medicine and genomics that are coming into play."
3. On decision-making with artificial intelligence and big data: "One trend I keep a close eye on is using analytics not just retrospectively, but also prospectively," he says. "The most advanced systems are really using data to make decisions and integrating artificial intelligence to generate better evidence about treatments and interventions that work in patients. We're just beginning to see how this research will reshape how we find out what interventions help individuals live better lives, along with how to inform providers at the point of care with good clinical decision support. That's what I would consider the next horizon, because although those analytics efforts are starting to really come into their own, there's still so much room for improvement."
4. On using predictive analytics to drive population health: "The ability to look at a bunch of different variables and predict which one of those will be effective in the future will be important. One of the things I'm particularly interested in is how we can use a dataset we have today to intervene before patients develop chronic diseases. It's this idea of being able to pinpoint folks who are at risk for diabetes or hypertension, before they develop the disease. It's also using analytics to evaluate interventions — some of which include social determinants of health — to improve those patients' lives and keep them well. There's been some progress on that with the Patient-Centered Outcomes Research Institute's work with diabetes and the CDC's National Diabetes Prevention Program, but there's a whole new horizon we haven't gotten to yet."