ONC’s First Chief Health Information Officer Says His Number-One Focus Is Interoperability

In the midst of all the activity at the HIMSS Conference, being held at the McCormick Place Convention Center in Chicago, Michael J. McCoy, M.D. sat down to share his perspectives on a range of topics with HCI Editor-in-Chief Mark Hagland. McCoy joined the Office of the National Coordinator (ONC) on Jan. 26 as that agency’s very first Chief Health Information Officer. Dr. McCoy joins Thomas Mason, M.D., ONC’s new Chief Medical Officer (who came on board on Feb. 23), and Andy Gettinger, M.D., ONC’s Chief Medical Information Officer (who joined in October 2014) as three senior officials who have all practiced medicine (Mason continues to do so part-time), and who bring practicing-physician perspectives to agency leadership—an important attribute to have these days, and to some extent a possible corrective following the departures of Jacob Reider, M.D.  and Judy Murphy, R.N., two senior ONC officials with clinician backgrounds who left last fall.

McCoy in fact has quite a varied background in healthcare. He was health system CMIO for a number of years, most recently serving in that role at the Detroit-based, 20-plus-hospital Catholic Health East, leaving after Catholic Health East was acquired by the Trinity Health integrated system. He has also worked as a consultant, and as a vendor executive, including in stints as vice president and medical director at Eclipsys and executive vice president and chief medical officer at DigiChart, an OB/gyn-specific electronic health record (EHR). He also spent 20 years in practice as an obstetrician/gynecologist.

With that varied background, and his recent experience as a CMIO still fresh in his memory, McCoy says that he wants to bring a strong clinician perspective to the chief health information officer role, which senior officials at ONC crafted for him personally. Below are excerpts from his interview Tuesday with Hagland.

Given your rich background and varied experiences, what would like to accomplish as ONC’s first chief health information officer?

My primary focus has to be on interoperability, because that’s the foundation for everything else. I would like to see where possible some reduction in the impediments for certification. I think a lot of the challenges are not because people in ONC or CMS [the Centers for Medicare & Medicaid Services] or any of the other federal partners doing this, have mal intent; instead, there are a lot of individual siloed areas [within government agencies]. It’s just that when you pile everything on [providers] all together [including intensifying requirements under the meaningful use program], it becomes… Well, you have to coordinate. And there are opportunities within the constraints of what is legislatively allowed. I’d like to do some things to streamline the certification process, making it more possible for usability to be considered. It’s not that it’s disallowed now, but it becomes more difficult to focus on usability.

Nor are the developers [vendors] the sole culprit. Clinicians, to their detriment, have not as been as engaged as possible in the selection or deployment of certain technologies. So there are many reasons for some of the angst out in the general public. That said, though, we have to get beyond the blame game around [vendor IT] products—we have to optimize the products out there, improving workflows, efficiency, and productivity and most of all focusing on the needs of patients. I personally want a more person-centered approach: health is not just healthcare. We need to help people make more informed decisions in their lives, and we need interoperability to help facilitate everything. And that will help to develop a learning healthcare system as well.

Can you speak to the consternation that some provider leaders are feeling regarding the provision in the proposed change to the Stage 2 MU requirements that would take the requirement that asks providers to get 5 percent of their patients to view, download, and transmit their health information and shrinks it to one patient per provider doing so?

Unfortunately, I’m not allowed to comment on that, because it’s found in an NPRM [notice of proposed rulemaking].

As meaningful use proceeds towards its conclusion, where will that leave us, and where should it leave us, with regard to interoperability?

Ultimately, it should support health system reform. You have to have data liquidity, which requires interoperability, to create that change. As we move towards paying for outcomes, we have to have the data liquid. Think in three buckets of the person, the panel, and the population, and it’s in that panel that the actual dollars will be spent. And the data has to be able to move among all the parties in there so they can optimize the care.

 And life beyond meaningful use is certainly what ONC is trying to position us for, so certainly the optionality in the NPRM for our certification rule is there to show that there is life beyond meaningful use, and that we are trying to position to allow for our certifications to be more meaningful in a broader context. It’s moving beyond the EHR; there are mobile applications and consumer and mobile applications; there’s the Internet of things. Those are all entry points into health, not just healthcare data. How do I perform when I’m exercising? What’s my diet? Those are all elements that inform parts of the system.

Given all that, would you like to accomplish as chief health information officer in the next few years?

Hopefully, I’m here at a time when I can make a positive impact in the direction towards, individual, person-centric care. That’s why the title was created just for me, of chief health information officer. And Karen [De Salvo, M.D., the National Coordinator for Health IT] apparently felt that there was sufficient value in my background—I’m just a simple obstetrician, but I think the experience that I have informs my view and allows me to look at things through the lens of a solo practitioner using an EMR, which I was, and then from the perspective of a CMIO at a seven-hospital system and then a 20-hospital system; having had all those different perspectives, gives one a unique viewpoint. And I want interoperability with data liquidity; I want improved usability of systems; and I want that individual person-centric ability for consumers to easily get to their data and be the focus of that care.

What would you say to providers who have found the meaningful use process clumsy, rigid, and challenging?

I would say all three of those critiques are in some ways accurate. Remember, meaningful use is a CMS process, not an ONC one specifically. And my predecessors worked with CMS to try to coordinate and collaborate on some activities. The challenge is when you get to some aspects like quality measures, there are different legislative mandates in different programs, and they don’t align. Some were designed for Medicare or Medicaid, and they don’t always align. So some of the requirements [in meaningful use and other programs] that are confusing or frustrating are there because legislators created them. So CMS is trying to follow the law. The flip side, and we don’t to get into the blame game, but physicians chose to participate. I didn’t see the federal government offer financial incentives for restaurants to deploy Open Table or for taxi drivers to implement Square. So we could go down a litany of reasons the system is the way it is. It doesn’t matter. We need to move past that. And when you look at what a provider can do, there are many ways they can optimize their workflow. They may have to work collaboratively with their vendor to redo their workflows.

Would you like providers to feel we’re all in this together?

We are all in this together. The ultimate goal should be to improve care for patients. There are no doctors I know who are out there to harm patients. And to help them [optimize care quality], let’s get some of the impediments out of the way, and let technology support them. But technology is a tool, it’s not the end goal. The goal is to build a house, not to choose the best hammer. We’re here to deliver care and hopefully deliver the information for better health, more broadly, more expansively.