From medical apps, to check-in kiosks at the doctor’s office, to telemonitoring- it is clear that innovation is changing the way health care is received and practiced. DW recently sat down with Medical Officer and Chief Strategist for Innovation in the Division of Science and Innovation, Office of the National Coordinator for Health IT, Dr. Rebecca Coelius, to talk about how the government is supporting innovation.
You self-identify as a social entrepreneur and are featured on this site because you are much more a disruptor than a classic government worker. What led you to DC?
Many of my friends thought I was insane for leaving a great job and a great husband in San Francisco, and if this isn’t the first it’s the second or third question people ask when we meet. Quite simply, I saw an opportunity to work very hard on a national scale on behalf of a community that I believe in, at a very special time in federal government when massive progress is being made in Open Data, Consumer Health, and transformations in how health care is financed. There are extraordinarily talented people all over the country right now chiseling away at health care. Even those of us in the middle of it don’t always appreciate the inevitability and scale at which this industry is about to transform.
There is an enormous amount that government can do to support innovation in the style of Gov 2.0; government as a responsive platform that enables citizens to experiment and make their world better through supportive programming, or simply knowing when to get out of the way. My goal here is to build upon the platform that has already been started by my wonderful colleagues and predecessors to support the health information technology (HIT) innovation community.
You have an interesting title, but what is your actual job and that of the Division of Science and Innovation (DSI) in the Office of the National Coordinator for Health IT (ONC)?
DSI sits within the ONC Office of Science and Technology, but is tasked to look across the entire ONC and other allied agencies to set the strategic plan and develop programming for innovation through health information technology (HIT). DSI has defined its role as removing unnecessary barriers to people experimenting with the development and use of HIT in transforming health care delivery, and identifying where there are things we can do to accelerate that progress. While our place within the ONC means we are focused most on the tech side, it’s important to work with our colleagues across HHS to connect the dots with the full ecosystem of providers, patients, payers, and other stakeholders. Technology and data that is not part of the larger innovation story is just not that interesting or meaningful.
Step one for DSI was to scale the bidirectional learning and communication between government and the innovation community. We are a big black box to most entrepreneurs, and its can also be tricky for our federal employees to stay abreast of the rapidly changing marketplace. Our Innovation Exchange programs launching this summer include virtual hangouts with federal employees with areas of deep expertise, twice monthly webinars with startup presentations and white papers that educate the ONC on priority market segments and issues, and ongoing educational activities and collaborations with accelerators around the country. We are also pulling together all of the government resources and regulations relevant to the HIT innovation community into a one step online environment cheekily called the Innovators Guide to the HIT Galaxy. This may sound like a lot of small things, but these interactions and knowledge sharing mean people make more informed decisions every day, and it changes the face of government from the unknown to dedicated people working on your behalf.
Through our Investing in Innovation program, we manage a large number of Challenges and Codeathons that encourage and reward developers to build for a specific problem of high interest to HHS like a public health issue, or uses a new standard for data transfer that we think has significant market potential. We have a Blue Button Co-Design Challenge running right now, and it represents all of the things that I am excited about in Health IT and the many facets of work we do at ONC. It is about empowering and engaging patients, leveraging creative thinkers and technologists to build amazing products with the potential to transform a small or large part of health care system, and shining light on new standards for data liquidity. In the first stage of the Challenge we crowd-sourced patient ideas and votes to define the highest priority use cases for patient data. Now we move to the active building phase of the Challenge, I invite your readers to participate as a patient co-designing with the developers, or on a competitive team!
We don’t have official programming in this area, but I am very interested in how we can learn from initiatives like Blue Button and the SMART Platform to develop a simple way for providers to securely move data from their EHR into other applications they use to take care of patients without the usual multi month timeline and many thousands of dollars of integration costs. This is a massive barrier to entrepreneurs trying to build provider-facing products, and for providers to test those products and develop a customized suite of technology to support clinical care. In some ways we are stuck in the 90s version of enterprise systems, where we build end to end solutions for people, instead of becoming a flexible platform for customization and rapid experimentation. I see a number of newer EHRs moving in that direction, and hope the others will follow close behind.
I’d like to see pilot programs scaled, and I mean the type of pilot focused on market and product development. Early stage companies need access to the clinical environment and providers need the staff band-with and financial support to experiment with and provide feedback on new tools. Startups areobviously highly incentivized to move beyond the pilot phase into other clinical environments, an issue which plagues many other types of pilots. I’m watching what happens in the Health Tech NYC PILOT program very closely.
Any other “Innovation” wishes?
The future is in new HIT enabled companies actually competing with the status quo organizations that we rely on to provide health care. The word disruption is constantly misused in HIT and digital health right now. Most companies are not trying to disrupt the status quo in terms of the major health care organizations and traditional foci of power. They are trying to sell to them. So every sales meeting you walk into is a classic innovators dilemma.
I personally believe we need to carefully open up competition between incumbents and newcomers, even newcomers that might provide what we have traditionally defined as medical care using very different people and methods. The virtual care and consumer health work is the closest to tech-enabled disruption I’ve seen yet, because they are directly competing with an existing health care service. The recent CMS announcement for a billion dollars in new health care innovation awards is such a cool opportunity for experimentation. CMS is asking for creativity in payment models, methods of delivering care, and incorporating tech. I hope there are a lot of providers and technology companies out there planning to partner and apply.
I’m very impressed by local governments getting involved for the sake of their local health care system and economy. Many communities around the country are setting up accelerator programs and other incentives, which is fantastic. There is also a need for leadership to do a lot of the hard work ensuring the data the entrepreneurs need can flow into and power the new technologies, an area where a number of state Health Information Exchanges are stepping up, especially the New York eHealth Collaborative
Any advice for other Silicon Valley Natives thinking of taking the DC plunge?
There are wonderful programs that make it possible for people with unique skills and life experiences to spend time in government, including the Presidential Innovation Fellows and HHSentrepreneurs programs.
It is vital to identify your allies early, I would have been hosed without a handful of people who have been incredibly patient and supportive helping me understand how to get things done here. When I walk into their office with an idea that I am really excited about, these allies don’t say no there are these ten rules and all of these people that say we can’t. They instead say here is how we can respect the limitations and responsibilities of being a public servant but still reach your goal, because in the end we are all here trying to transform health care.
Rebecca Mitchell Coelius, MD is the Medical Officer and Chief Strategist for Innovation in the Division of Science and Innovation, Office of the National Coordinator for Health IT. She previously founded and ran the international non-profit SpanAfrica, has consulted for and advised a host of inspirational health care startups, had a previous life in global health and development research, and is a free-lance writer.
All views and statements herein belong to Rebecca Mitchell Coelius, and do not represent official positions of the Office of the National Coordinator for Health IT (ONC) or Health and Human Services (HHS)