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    The World of Medicine My Physician Daughters Will Inherit

    B. Vindell Washington
    B. Vindell Washington, MD, MHCM

    Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members. 

    My twin daughters will receive their medical school diplomas from the University of Virginia School of Medicine in 2017. The world of medicine my daughters will inherit is much different from the one I entered as a physician in 1990.

    New tools, reforms, and innovations are affecting the entire health care delivery system, especially in information technology (IT). When my daughters begin practicing, many of their patients will already be able to access their own health data from their electronic health records (EHRs) or health trackers. As new attending physicians, my daughters will be expected to work with their colleagues, as part of an integrated care team, and to combine all of the information stored in EHRs into person-centered care plans customized for each patient.

    Today we are already seeing innovations in care and technology, many of which are well beyond the possibilities that we envisioned only a decade ago. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 spurred widespread adoption and use of health IT.

    As a result, nearly all hospitals and three-quarters of physicians are using certified EHR technology—extraordinary strides in just a few years. There is now a huge amount of electronic health data that simply did not exist a decade ago. More importantly, an increasing number of clinicians are using health IT to better connect with their patients and with other providers in an effort to coordinate patient care. For example, 82 percent of the nation’s hospitals are electronically exchanging laboratory results, radiology reports, clinical care summaries, or medication lists with ambulatory care providers or hospitals outside their organization—double the percentage from 2008.

    More opportunity, room for improvement

    Our work is not done. We need to do more to ensure information will flow where and when it is needed for everyone, regardless of the setting. We are already seeing progress through efforts like publishing application program interfaces and developing fast health care interoperability resources, which will enable different digital systems and tools to speak the same language. Health IT developers and vendors who provide more than 90 percent of the EHRs to U.S. hospitals have pledged to implement these common, federally recognized interoperability standards.

    “Today we are already seeing innovations in care and technology, many of which are well beyond the possibilities that we envisioned only a decade ago.”

    B. Vindell Washington, MD, MHCM
    Office of the National Coordinator for Health IT

    But we cannot forget the most important part of the chain: our relationship with our patients, many of whom are more involved in their own care than their parents or grandparents were. They are generating, monitoring, and tracking their own health data, such as blood pressure readings, and expect that this information will help inform their care. Many of them are looking for additional tools to enable them to share their data with their clinicians through programs such as Blue Button or Get My Health Data.

    In addition to sharing information with their providers, individuals would like to share their health—and genomic—data to accelerate us into the next generation of medicine through efforts like the Precision Medicine Initiative. This information will lower costs for researchers who are translating results from clinical trials into research databases to discover new treatments and patterns in illnesses, faster than ever before. In the past, these data were available electronically but had to be aggregated and reviewed manually. Now clinicians can help guide research protocols and more easily integrate these data into EHRs to help them make the best clinical decisions for their patients. These exciting efforts will enable the system to move from empiric treatments based on general phenotypes and demographics to more specific treatments based on genomic makeup.

    All of this information is helping us build and strengthen a learning health system, a system in which the data can improve the health of individuals and the communities where they live. Such a system will soon be vital to market success, as we transform the way we pay for care from a system that rewards providers for the number of treatments they provide to one that pays for improving the quality and coordination of care. In March 2016, the Obama administration met its ambitious goal of tying 30 percent of Medicare fee-for-service payments to quality and value through alternative payment models by the end of 2016. This ambitious goal was achieved nearly a year ahead of schedule. A seamless, secure information infrastructure is foundational for this new approach to Medicare payment.

    I am encouraged about the path we are paving for my daughters and other young doctors. As they embark on their medical careers, the groundwork we lay today will help them provide better, more person-centered care for their patients, while helping these patients better manage their health and health care. That is important work.