HIStalk Practice Interviews Robert Wah, MD President, AMA

Robert Wah, MD is president of the American Medical Association and serves as CMO of Computer Sciences Corp. He also practices and teaches at the Walter Reed National Military Medical Center and National Institutes of Health in Bethesda, MD.

How did AMA’s relationship with Matter Chicago come about? I got the chance to stop by the health IT startup hub’s new offices while in Chicago for HIMSS last month, and am looking forward to seeing the AMA “Physician Office of the Future” that will eventually be housed there.
I’ve been on the board for about 10 years, and during that time we’ve been really pressing to expand our horizons to look more at innovations, as well as what I call service delivery excellence, in all that we do in the AMA. The Matter relationship is just a fruition of some of the work that we’ve been doing to think about how we, as a 107 year-old organization, can continue to look to the future. Because we’re co-located in Chicago, it’s an easy geographic relationship to establish, plus Matter is also on the cutting edge of providing a structure, framework, and physical location where we can start working on these innovations that we’ve been talking about. It will be a good ecosystem where we can start testing new ideas to see how they work together and actually fit in place.

Given AMA’s focus on innovation, how have you seen that buzzword take on more concrete meaning over the last several years?
Innovation today is tomorrow’s reality. As we’ve talked about innovation over the years, many of those things have come to fruition and are real today. Some didn’t progress as we might have expected five years ago. My background is in health information technology. We certainly are seeing a significant conversion from paper-based systems to digital-based systems. The innovation that’s going to follow after that conversion I think we have yet to completely see. Obviously, it’s a big step just to get off of paper onto a digital platform. I think we are all expecting and hoping to see the benefits of moving from paper to digital. That’s where I think the future innovations will come from.

We’ve got some examples of it. The example I often use comes out of the DoD. I haven’t written a prescription on a piece of paper in a military facility in over 20 years, and that’s a remarkable statement. The benefit is that now I have the ability to check against a real-time database to make sure that anything I’m prescribing today isn’t going to interfere with something the patient’s already on or duplicate it, or interfere with an allergy. That’s pretty remarkable. We’ll see more of that expand as more information becomes available digitally and it’s networked together. I’m pretty excited about all that. I think there’s been a lot of bumps in the road and probably more to come as we progress down this pathway, but the promise is great. There’s still a lot of pitfalls along the way, though.

How do you foresee innovation impacting interoperability? Will that ultimately come from the government, established businesses in the private sector, or startups?
It’s going to come from all three. I think that there is potential for all of them to have significant impact on interoperability. The DoD will certainly play a leadership role. On the industry side, it’s going to be new companies we’ve never imagined before coming into the industry to disrupt the status quo, which may lead to interoperability. At the same time, they will put pressure on the established systems in the market to also move towards interoperability because that’s the nature of competition. I think all three of those entities will have a hand in moving us to an interoperability ecosystem.

There’s been a lot of talk lately around “information blocking.” How do you foresee digital health tools moving data exchange forward?
I think that in many way the big “aha” moment in most technology industries was the establishment of enterprise resource planning systems, where the data is pulled from around the enterprise and made available to everyone, making the whole enterprise much more effective and efficient.

As in a manufacturing company, they used to have a sales part of the organization, a manufacturing part of the organization, a finance part of the organization, and logistics to get raw materials. When ERP came in, all of those functions were putting data into the same system so each part could see what the other area of the enterprise was doing. When somebody took an order in on the sales side, it immediately alerted the logistics people to get raw materials to make the manufacturing part of the company ready to produce whatever the sales person just sold. That’s an example of an ERP radically improving an enterprise.

In some ways we’ve had an expectation that the EHR would be the ERP for healthcare. Physicians are frustrated about having to be the data source and the data entry system for the ERP of healthcare. We as physicians would like the electronic record to return to its roots of being a clinical record of information rather than also being a compliance tool, finance tool, and a resource tool. All of the functions that we’ve laid onto the EHR that are more appropriate to an ERP system requires a doctor to meet all those requirements. That’s one of the big frustrations we have. I’m hoping that in the future there’s going to be a new layer that gets established that serves all those ERP functions and allows the electronic record to go back to its natural roots, which is to be a depository of clinical information.

You mentioned freeing up the doctor. How do you see physicians responding to the increasing role of patients in their own care?
I think we as physicians want to find a way for them to be able to fulfill that desire to engage. Electronic records and digital systems are one way that they can do that. I think we’re all interested in finding better ways for us to be able to engage our patients.

Last fall, the AMA put out our paper on the things that we’d like to see happen to improve electronic records. We convened a group of health IT experts and practicing physicians to develop a paper that answers the question, “If you were able to sit down with an EHR vendor tomorrow, what would you ask for?” There were eight major points they wanted to see improved in EHRs. One of those eight points was that EHRs should be able to accommodate this desire of our patients to engage, as well as use mobile devices.

When it comes to patient engagement, what are your thoughts on the scaled back Meaningful Use criteria? Are physicians breathing a sigh of relief?
We’re encouraged by the fact that it appears CMS and the ONC have heard the concerns we’ve been raising about Stage 2. It does look like they’re trying to respond to some of them. We have been concerned that, in many cases, physicians are responsible and at risk to be penalized for things that they don’t ultimately control, like how often a patient decides to connect to the office via a patient portal. That’s very hard for us to have any control over. We can’t follow them home and ask them to log in. It’s a very desirable thing that we do it, but it’s just hard to see how a doctor can necessarily control that. That was a big challenge for us. Fortunately, it looks like there’s going to be more flexibility coming from CMS and the ONC.

Your military background is fascinating to me. How do you see digital health innovations impacting the care of service members and veterans?
Obviously I’m biased, but I think the military healthcare system provides some of the best care in the world. I certainly believe we provide some of the best medical education and training anywhere in the world. I’ve been privileged to be a part of the military health system for most of my career. At the same time, I’ve had the opportunity to be on the faculty of several medical schools, including Harvard. From that perspective, I can say very confidently that military and federal medicine provides some of the greatest care in the world. I’m very optimistic and encouraged that they will continue on that trajectory of always providing great care for our military service members, their families, the retired, and our veterans. I think they are at the forefront in many cases of using technology to do that.

As I noted earlier, that real-time database is a really unique thing and it’s all powered by the fact that we’ve had the ability to write electronic prescriptions for so very long. I think we’re way ahead of private healthcare in that regard. I think right now they are in the process of looking at how we take the next leap in health information technology, both from the DoD and the VA. They are looking for flexibility and agility, and how to use technology to take better care of your patients. I’m very encouraged by that.

What are your plans once your time as AMA president ends next month?
I hope to continue to see patients and teach. I really find that very rewarding. I’ll continue to serve on the AMA board for an additional year as the immediate past president. Beyond that, I’ve had a lot of offers and some pretty exciting opportunities come my way, and I’ll be looking at those over the next 12 months.

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Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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