From the moment I got my first look at the power of what electronic health data could do, I was sold. And now, after more than three decades of caring for patients while also working to advance the field of clinical informatics, I’m excited to share that I’ll be joining Health Gorilla as Chief Medical Officer this October in my continuing efforts to make nationwide interoperability a reality.
My goal has always been to improve health by making healthcare better and, in this next chapter of my career, the urgency to innovate will take center stage. I can think of no better place to do that than Health Gorilla. I believe Health Gorilla is well positioned to become the largest interoperability network and platform for our healthcare system.
As a primary care physician for over three decades, healthcare runs through my marrow. I have always been an enthusiastic proponent of electronic medical records (EMRs) – which sets me apart from some of my fellow doctors. I know that EMRs get the blame for part of what’s wrong with healthcare, but I also think they are a critical part of the solution, at least for the time being. Over the years I have heard lots of whining. “I hate computers! Who moved my cheese?” I get it. Doctors feel overwhelmed, undervalued, and are trying to survive in a rapidly changing world.
But without access to patient data, care suffers. That’s why I threw all my eggs into the interoperability basket.
We are burdened with this incredible challenge of high cost and poor outcomes and it’s worse in the U.S. than anywhere else. We spend more money and get the worst outcomes of anywhere in the developed world. It’s terrible. One of the contributing factors to this problem is a lack of data access, but I believe we can fix that.
Throughout my medical career, I have believed strongly that I could only deliver high-quality care to my patients if I had a comprehensive view of their medical history. Before EMRs, that meant giant file cabinets in my office with shadow charts so I could immediately put my hands on the information I needed. I was thoroughly committed to data access even in the pre-computer medical world.
When the EMR became available, I was totally sold from the beginning. But I was one of the creators. I was personally involved in building one of the very first digitized health records systems in the 1990s.
The seed was planted about 10 years earlier, though, when as a third-year resident working in the ER at Kaiser San Francisco, I got my first glimpse of electronic medical records and the immense good they could do.
That was my introduction to the idea that you could computerize electronic health data, making it organized and accessible. It was a homegrown, Mac-based documentation system and – as someone who had done some programming in college and built databases – it struck me powerfully. It just clicked for me that if health data were more organized and available it would allow doctors to do a better job.
From my residency, I joined the faculty at University of California San Francisco and there I reached out to the IT department about optimizing the hospital data system and making it more useful and friendly for clinicians. I was always kind of a techie and I wanted to make the computers work for the clinicians and patients, not just the billers and the lab.
In 1992, I started my family practice at the Palo Alto Medical Foundation, part of Sutter Health. Before I started, they asked me what color carpet I wanted in my office. I said, “I don’t care but I need a computer on my desk. They said, “you’re nuts! What is a doctor going to do with a computer?”
But I found some kindred spirits and spent the better part of the early 1990s doing a full vendor analysis of what products were out there and thinking about how we could persuade an established healthcare organization to join the digital revolution. In 1996, Sutter Health became the third EMR customer of a little Wisconsin company called Epic. Over the next three years, another doctor and I worked on interfaces to get it configured. It was up and running in 1999, just as the EMR/electronic health record (EHR) movement was beginning. So as you can see, I was an incredibly early adopter.
Our practice sent many of our patients to Stanford University Medical Center, but at first – even after Stanford implemented the same EMR vendor system – we could not share digital information. It was all faxes and carrier pigeons for a while there. So the idea of being able to make interoperability work began first literally across the street with Stanford, then in our Northern California region, then statewide, nationally, and really now internationally. I am very interested in developing and supporting international interoperability.
After years as an EHR builder, champion, and program lead, I became the Clinical Informatics Director of Privacy, Information Security, and Interoperability at Sutter Health. Based on my local and regional engagement, I became involved in the Epic Care Everywhere Governing Council, and various governing committees at Carequality, DirectTrust, The Sequoia Project, and the HL7 Da Vinci Project. In 2017, I was appointed to the federal Health Information Technology Advisory Committee (HITAC), which has provided an unparalleled opportunity to understand and contribute to the development of federal health IT policy and standards.
In my new role at Health Gorilla, I will lead efforts to become one of the first designated Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA). As current chairman of the Carequality Steering Committee, and a member of the Board of Directors of The Sequoia Project, ONC’s TEFCA recognized coordinating entity, I know and have developed close working relationships with all the players and that’s part of the value I bring to Health Gorilla and the larger TEFCA effort. I have a real desire to make this work, and a sincere belief in Health Gorilla’s abilities to be a key part of the solution.
For the past five years, I have participated in and led policy discussions and workgroups to shape landmark interoperability standards, networks, and frameworks – often as the only practicing doctor in the room. But now I am ready to go part-time at my practice and make interoperability my top focus.
The difference I want to make in the world for the rest of my career is to solidify the foundational tools of interoperability. I firmly believe that we can improve the care of individuals and populations and we can improve the value of healthcare with more reliable access to health data. I want to build on the connectivity I’ve helped to establish and bring it to the next level.
I personally know the Health Gorilla founders, having worked alongside them at Sutter and Carequality. But the main reason I joined Health Gorilla is that, as I look around, I don’t think any organization is better prepared to really make TEFCA work for a broad population of use cases and users.
I believe this in part because, unlike the other potential candidate QHINs, Health Gorilla is a neutral player with best-in-class technology built natively on FHIR. FHIR is clearly the direction we’re going. The RCE said just last week that it expects the TEFCA FHIR Roadmap to become operational as early as 2023.
As someone who has spent his entire career in the not-for-profit sector, I have to admit that getting things done in this environment can be extremely difficult. At this point I feel like I’ve had as much direct impact as I can in a not-for-profit organization and I want to accelerate my ability to do good in the world in this way. I really like to innovate and to push the envelope for the good of patients, healthcare, and society.
I have a five-year plan and I think we can get it done. I want to stand up a first-generation QHIN and support its evolution from the first set of use cases to serving critical healthcare needs across the country.
I’ve spent 36 years as a doctor using my one-to-one interactions to improve health but that only goes so far. I am ready to run with scissors, to be nimble and responsive, and get things done more quickly. That’s why I’m thrilled to join Health Gorilla.
