10 Questions With Michael James McCoy, MD

This is the first of a new “10 Questions” series, which will feature the answers to 10 questions posed to a diverse group of professionals in the women's health community.[[{"type":"media","view_mode":"media_crop","fid":"32482","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6995186072308","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3431","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; float: right;","title":"Michael James McCoy, MD (Image credit: HealthIT.gov)","typeof":"foaf:Image"}}]]

1. Please state your name, title, and the organization you work for.

Michael J. McCoy, MD
Chief Health Information Officer
Office of National Coordinator for Health Information Technology
U.S. Department of Health and Human Services

2. How did you get to where you are today?

It has been a somewhat serendipitous path, with my foray into informatics occurring later in the course of my clinical (private) practice. After helping pilot implementation of an office EMR for my practice within our hospital system (and being a part of the due diligence team looking at a variety of candidates across the country), the progression to CMIO for the system, and ultimately selection of an acute care (hospital) system, I became visible to some in the health IT sector and was offered an opportunity to move from clinical practice to the EMR vendor world.

From there, I’ve had many “learning experiences,” as transitioning from a system where one is complete ruler of one’s domain (my office) to the corporate environment where being right is not enough! Having worked with two different vendor systems from the inside-from consulting practices where helping organizations reach the proper conclusions on strategic (and operational) matters and helping with standards development to improve both patient care and usability of electronic health information by clinicians-my current position has cascaded from that transition.

3. Initially, why did you choose obstetrics and gynecology as your specialty?

When I started medical school, I had no idea what I would like to do. Most rotations were fun and could have been a path, but after doing my Ob/Gyn rotation, I knew that had the best combination and balance (medically/surgically speaking) of the bunch. To me, it provided the opportunity to see patients both short- and long-term, generally for happy events, with an office component and a surgical one. Obstetrics and gynecology as a field has long been among the technology leaders within medicine, with early adoption of laparoscopy, lasers, electronic fetal monitoring, etc.

4. What was your favorite thing about obstetrics and gynecology?

I most enjoyed the surgical aspects, and think I was technically very proficient. (My quality scores were near the top, if not the top, among my peers.)

5. What was your least favorite thing about obstetrics and gynecology?

The lack of sleep was the worst, as I was in solo practice (sharing call every other night and weekend with another solo practitioner). My wife says I am a much nicer person now that I am not sleep deprived.

continued

6. What led you to focus more on health information technology?

I’ve always been somewhat (ok, a lot) geeky and was often on the bleeding edge of technology. I saw the value of integrating the same technologies that were used in other industries in my practice, and subsequently in other positions. I am firmly convinced that technology as a tool can enable better patient care and improve physician productivity. The challenges to that remain in the usability of EHRs, the interoperability between various entities (both inside and outside of an organization), and cultural changes that must occur by users.

7. How will your life as an Ob/Gyn intersect with your new role at the ONC?

I think that, as I mentioned above, a background as an Ob/Gyn provides experience as a busy obstetrician in an office setting, as a surgeon dealing with all the normal OR issues, and as a private doctor, the productivity concerns. I understand the social media interactions that surround both patient/family/physician interactions with happy events like the birth of a new family member. I’ve experienced the office (“private doctor”) versus hospital (“them”) concerns from both sides (a practicing doctor and a CMIO for health systems). And I’ve been privileged to help The American Congress of Obstetricians and Gynecologists in the past with some perspectives on health care IT concerns they have had.

8. What are the biggest obstacles in the fields of Ob/Gyn and health IT?

Two different concerns:

For Ob/Gyn, I am concerned particularly about the obstetrical practice side. I practiced collaboratively with advanced practice nurses and with certified nurse midwives, both while in the military service and in private practice. In other countries, with better neonatal outcomes than we have in the United States, a substantially higher percentage of deliveries are done by midwives. With the drive to lower US health care costs, and an increasing patient demand, I think a continued shift towards birthing experiences attended by non-obstetricians is likely. That will be a major cultural shift, and perhaps cultural shock to obstetricians.

In Health IT, I think the biggest obstacle is usability of systems, partly driven by the need for improved interoperability (including limiting to a common data vocabulary) and improved vendor/developer delivery of systems that don’t just meet their perception(s) of the “minimum required” standard or regulations. For example, there has been a lot of banter about the “un-usability” of the CCDA (Continuity of Care Document), as being a “data dump” that is unreadable. The reality of the regulations is that Organization A’s EHR must send all the data, and Organization B’s EHR must consume it, but how it displays to an obstetrician versus an ophthalmologist likely needs to be different for each to meet their needs. There is no prohibition to that in the regulations, so vendors/developers can have different displays of the information by specialty, etc. That is extra work for them, and extra work for the large hospital systems to keep up with various special views that might subsequently be needed/desired.

9. What's your best tip for maximizing effectiveness and minimizing frustration when it comes to entering data into EHR systems?

First and foremost, be involved in the decision process, if at all possible, before the EHR system is selected. If one is already in place, then work with the clinical informatics team at your institution to help identify barriers to success and what improvements in workflow might be possible. I want to be crystal clear here: many of the implementation of EHRs do NOT fully exploit the functionality or capabilities native to the system. That is not a vendor/developer issue! However, many systems are less than ideal in their capabilities.

A second thing to keep in mind is that it may be that your workflow is what needs to change, rather than warping the software and deployed workflows to your existing processes.

Use of patient portals to pre-populate much data is possible with many/most vendors/developers and will offload a significant amount of (somewhat) mundane work from you and your staff.

Finally, utilize the HIE and interoperability capabilities to pull in data and validate its accuracy. The more people who use (and scrub) the data, the more useful the system will be.

10. If you could give the obstetrics and gynecology industry one piece of advice, what would it be?

Be prepared for, and get on board with, a significant shift in practice, with consumer-driven activism and preferences becoming significant. In many other countries, significant direct access to laboratory tests and medications exists, not requiring any physician order, and foretells the possibility of physicians becoming irrelevant if they do not adapt to the changes (see above on licensed independent practitioners). Use of mobile technology and the world of connected devices (Internet of Things) will impact us. If the field of obstetrics and gynecology is to continue being the sponsor for best women’s health care delivery, significant cultural adaptation is imperative. Use of health information technology is but one part of that culture shift. I hope that my colleagues understand and embrace these changes, as they are inevitable.