From Haiti to Health IT: My Journey to ONC
Dr. Vindell Washington | May 26, 2016
I found my passion for health information technology (health IT) in the unlikeliest of places: a combat support hospital in Haiti. During my time as a Captain in the U.S. Army, I was assigned to support the 18th Airborne Corps. While deployed in Port-au-Prince, a superbly fit 20-something fellow soldier presented to my colleagues and me with confusing signs and symptoms. He came to our field hospital emergency department appearing generally ill with a rash, and we knew neither his diagnosis and appropriate treatment nor his prognosis. After considering our options, we set up a telecommunications kit on the roof of a Humvee and linked with our support unit, the Walter Reed National Military Medical Center in Washington, D.C. Specialists there helped us to diagnosis the first case of porphyria—a rare, often genetic skin or nervous system disorder—in my clinical practice. This primitive connection with a premier institution was invaluable and allowed us to properly diagnose and treat our patient. I recall thinking at the time, “the way we traditionally think about practicing medicine will never be the same again.” Once you have access to any technology that allows you to significantly improve patient outcomes, you never want to go back.
I have always had an interest in medicine. Growing up in a small Virginia town, I performed well in science and biology, but it was a personal connection that really led me into the profession. In 1964, my grandmother had a pituitary tumor that was successfully removed. However, the procedure left her blind. Wanting to learn more about how this could happen, I became increasingly curious about vision, medicine, and the biology of life. I attended Penn State University on an Army ROTC scholarship and went on to earn my medical degree from the University of Virginia and a Master of Science in Healthcare Management from the Harvard University School of Public Health.
In the Field
As an emergency room resident in the early 1990s, I had a small personal digital assistant (PDA) that I thought could help me practice medicine more efficiently. I spent hours making lists of doses and algorithms on my PDA for administering relatively complex patient treatment patterns that needed to be available at a moment’s notice where there was little or no room for variation. To me, this was an opportunity to improve patient care through the use of technology. Looking back on it now, it has become even more apparent that we have an amazing opportunity to take our work to new heights when we put to use the technology that is at our fingertips.
I continued to see the power of health IT throughout my career. As recently as 2014, as a mid-career doctor in a new practice location in Louisiana, I had not yet developed many close connections with other providers in the area. A patient with severe bradycardia—an abnormally slow heart rate—showed up in the emergency department. Had I encountered this patient just a few years prior, tracking down his medical history and discussing the case while in a still unfamiliar health care community would have presented a number of obstacles. However, because of advances in information sharing, I was able to simultaneously review the electronic medical data, his response to treatment and develop a care plan with a cardiologist, even though we were miles apart. If that technology were not in place, it would have taken many hours to develop a care plan, find an accepting physician, get an assigned bed, and arrange transportation from a remote facility – not minutes.
These days in my practice, I have a particular interest in and passion for clinical decision support—electronic tips and tools that can be incorporated into doctors’ and nurses’ workflows to improve patient outcomes. Here at the Office of the National Coordinator for Health Information Technology (ONC), we are working closely with our colleagues at other agencies in this area.
Let’s say you are having hip surgery and will be on your back for a long period of time. As many health care professionals will tell you, the risk of blood clots is of significant concern in a hospital setting, so it is critical for providers to remember the recommendations from the society of chest medicine on how to manage potential stroke and bleeding risks. An effective electronic health record (EHR) would support these clinical decisions by cataloging the patient’s prior medical history, the scheduled hip surgery, and levels of anticoagulation and using that information to guide the care team. I have deployed these systems in practice settings and have seen, time and again, that clinical decision support has empowered me to practice higher quality medicine. That is just one example of the promise of health IT.
Where We’re Going
As the Principal Deputy National Coordinator at ONC, I am striving to put that health IT vision into practice by helping clinicians and individuals across the country harness technology to improve health and health care. In the near term, I am focused on accelerating ONC’s work with our partners in the public and private sector to achieve tangible, ready-to-use outcomes that demonstrate the free flow of information and its ability to empower patients.
To get there, useful and useable electronic health information needs to flow freely, from research institutions and quality improvement body databases, to EHRs and other transactional systems, to consumer-facing apps, and back again. This data ecosystem can and does enhance clinical care at the bedside—as I have seen in my own practice many times over. This is part of the true promise of health IT.
We also have to help change the culture around access to information, including both providers and patients. Empowering patents to be partners in their health care by accessing their health data and accelerating and simplifying the flow of health information between clinicians and across systems is vital for better quality of care.
And, speaking as someone who has spent a large portion of my career providing care in the private sector, we need to make sure that government rules and regulations reflect the principle that data moving simply and securely throughout the healthcare system is vital for market success. That means rewarding quality and outcomes, providing flexibility for the many different care environments that exist across the country, and reducing burdens for doctors and nurses in the field.
Back to Basics
I have been blessed to work around a lot of talented folks throughout my years. However, talent and intuition, on their own, do not always lead to success. As my father taught me, almost anything worth achieving in life requires faith, hard work, and persistence. It is going to take hard work and persistence in order to achieve a connected, learning health system. This technology journey is not perfect, but if you look at where we have been, great strides have been made. And I can’t imagine us going back.
It is truly an honor to once again serve my country here at ONC. In the coming months, I will be sharing more of my perspective and priorities here on the Health IT Buzz Blog. I encourage you to follow along. You can also follow me on Twitter, @VindellW, where I will be sharing some of the latest health IT information, resources, and events.
In the meantime, I am looking forward to delivering the opening remarks during the 2016 ONC Annual Meeting, “Committed to Better Health Through IT,” with many of our partners across the health and health IT landscape. I hope to see you there!