world that we’re living in. But we haven’t really allowed technology to support and enable physicians and the rest of the care team using things like A.I. or machine learning, in a way that we have in other sectors. Helping physicians feel comfortable with that—to know what are the ways that data is an enabler and not a barrier—is such an important future for us. We want to make sure that we’re building a workforce that is taking the best of technology to do the best for their patients.
X: When it comes to optimizing how health data flows and follows patients as they receive care, some of the key stakeholders are healthcare providers, software companies, government, and academia. What’s one example of a situation where the interests of all of those parties are aligned?
KD: I would think the area where everybody’s interests are aligned for data flow and sharing is in disasters. We saw that recently in Texas. There was a rallying cry and then action on making sure that individuals who were needing care in the shelters from the Houston hurricanes, from Harvey, were able to access their health information. Disasters always remind us that information not only saves lives but can [also] reduce suffering.
X: What’s an example where some stakeholders’ interests are in conflict?
KD: I think the place where interests are not yet aligned is in the everyday practice of medicine.
We have made some progress but patients’ information—even though now digitized, and even though they should control it—is still thought of as an asset that’s owned by a practice or a hospital, in the way that an old paper medical chart was considered an asset of a physician’s practice.
As a healthcare system, we haven’t quite got to the place where we recognize, “It’s not about the chart, it’s about the data; and more importantly, it’s about the patient.” The work that I did at HHS as national coordinator was about freeing that data on behalf of consumers so that they could access it when and where it mattered to them.
Congress actually passed a law to say that it’s not ok to block someone’s data. The healthcare system needs carrots and sticks … to make sure that we’re putting people first, and not [guarding] data too closely, because then it’s not there to help them.
X: The stimulus package Congress and President Obama approved in 2009 included $29 billion in incentives for U.S. hospitals and clinics to adopt electronic health records systems. Do you feel offering these incentives to healthcare providers turned out to be an effective strategy?
KD: The quick answer is “yes.” The encouragement model of adoption didn’t accept that physicians and hospitals needed some encouragement [in the form of] funds to offset the cost of adoption.
In hindsight, what [government leaders] were trying to do was push the adoption of electronic health records, because that made sense at the time. Think about the world in 2009. There was barely an iPhone. Everything was about hardware and software. Now we understand the currency is data. It’s not this digital health record.
Ten years ago, there was a need to infuse and push. We did that. But I think in that journey, it became really clear that
