Former National Coordinator offers Dr. Vindell Washington advice on his new position

Vindell Washington, MD, assumed the National Coordinator role last week as Karen DeSalvo, MD, transitioned out to focus full-time on her duties as HHS' acting assistant secretary for health. As Dr. Washington begins his new job, former acting national coordinator Jacob Reider, MD, offered him some advice on what to expect and what to tackle.ational coordinator in 2014, assuming duties after Farzad Mostashari, MD, and before Dr. DeSalvo.

In a post on The Health Care Blog, Dr. Reider wrote that certification is central to the ONC, calling it the core of the department's responsibility to the nation. Stakeholders have questioned the ONC's certification program and requirements, suggesting such programs are outside the department's boundaries. But repealing it, Dr. Reider wrote, would be disastrous. "As a product of ONC's certification program, we now have health IT systems that do what their developers claim they do," he wrote. "Is the certification program perfect? No. Of course not. The program needs to iterate with the evolution of the industry and the standards that are evolving."

Dr. Reider also commented on ONC spending and appropriation, all of which falls under the national coordinator's responsibilities. He wrote that project proposals always exceed available funds, and the national coordinator has to make the "tough calls." Doing so, though, can be difficult when the national coordinator doesn't know who the successor will be. When Dr. Reider was leading the ONC, he said they delayed decisions on approximately $2 million in funds to provide Dr. DeSalvo some flexibility around programs when she assumed the reins.

However, Dr. Reider is also of the belief that the ONC should "wind down…grants and health IT evangelism activity." He wrote it isn't the government's job to convince the public of health IT's value; rather, the value, if it exists, should be self-evident. As such, Dr. Reider suggests getting rid of the ONC's annual meeting, "an event that costs several hundred thousand dollars and attracts the same participants every year" and doesn't add much to progress in the arena.

Dr. Reider also discussed focusing on quality, not on quality measures but on quality improvement. Tracking quality measures, he wrote, is flawed because many measures seek information that EHRs haven't captured. "Quality measures are still proposed without consideration for the data that EHRs have captured," he wrote. "If the concept that you want to measure isn't in here, then re-design your measure, because the EHRs don't capture the data in a uniform manner."

Finally, Dr. Reider said it's vital to "focus on the most important things," and that is whether the department is helping improve people's health.

"Karen DeSalvo taught me many things when I was her deputy — but the one I've internalized the most was something that she taught me very early in her time at HHS:  We need [to] shift our conversation from how to improve "health care" to how we improve health," he wrote.

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