ONC's New CMO Talks Meaningful Use, EHR Implementation Strategies & More

by Kate Ackerman, iHealthBeat Editor in Chief, iHealthBeat, Monday, March 30, 2015

In late February, Thomas Mason took over as CMO at the Office of the National Coordinator for Health IT. In his new role, Mason oversees ONC programs and clinical coordination within the agency.

Before joining the agency, Mason was the chief medical informatics officer of the Ambulatory and Community Health Network of Cook County Health and Hospitals System. He's a board-certified internist who has led multiple electronic health record implementations and has a strong background in public and population health.

In an exclusive interview with iHealthBeat, Mason discussed how his experience using an EHR system on a daily basis has helped prepare him for this new role, how the meaningful use program is working on the ground and what he hopes to accomplish in his first year at ONC. 

iHealthBeat: Why did you decide to join the Office of the National Coordinator for Health IT? What attracted you specifically to the CMO role?

Mason: I've dedicated my entire career to public service. Earlier in my career as a medical director of a group of federally qualified community health centers in Chicago, I was tasked with converting our paper-based system to an electronic health record system. And, it was at that time, that I really saw and realized the potential of information and technology if used the right way to be a major driver to improve quality, to improve patient safety, to improve clinical outcomes and also to improve efficiency.

So I've been very passionate about leveraging technology and information to improve health, improve health care [and] to decrease costs. And, I really feel like moving from the local government level to a national stage really allows me to broaden my reach, to really help make a difference and help improve the health care delivery system to be better and more efficient.

iHealthBeat: What do you think your biggest challenge will be in this new position?

Mason: I think personally the biggest challenge will really be balancing work with family. My family is transitioning here to D.C.

And professionally, I think again the transition from local to federal government. But I also think that's an important benefit because I'll be able to bring my practical and local level experience and expertise in leveraging technology to improve health to a national stage and really sort of help to inform a lot of the policies that have been designed with front-line provider perspective and giving feedback and helping to sort of guide and lend that expertise to the development of future policy and rules here at the ONC.

iHealthBeat: That's actually a great segue to my next question. How has your experience as an internist and chief medical informatics officer at Cook County Health and Hospitals System's Ambulatory and Community Health Network, as well as your experience before that, prepared you for this new role at ONC?

Mason: I think in a few ways. First, being an active clinician. Most recently, I had an active primary care panel in addition to being our ambulatory CMIO at Cook County. I think really giving the perspective of someone [who's] using an electronic health record system on a daily basis and being able to give that feedback during the design session [is] really invaluable in helping ensure the workflow design makes sense. One of my early wins at Cook County in really gaining the trust of the physician community was focusing on the physician documentation experience and really focusing in on usability and efficiency. I led the design of a template ambulatory progress note that when providers opened the note, we'd leverage the technology of the EHR to auto-populate patients' preventive health measures, the last date of health expectations, like last mammogram, Pap smear [or] lipid panel. ... Physicians saw that using electronic documentation would actually help improve their efficiency [and] that they didn't have to navigate through the chart electronically to find certain things. They were just there. It was sort of an initial trust that was built that as CMIO, I'm really focusing on how can we make the experience better, more efficient, how do we integrate the quality and safety features and not make the system more cumbersome.

iHealthBeat: Thinking back to just a couple of months ago. How is the meaningful use program working on the ground? What has Cook County's experience been?

Mason: I think workflow redesign for achieving meaningful use has worked very well in certain areas and has been challenging in others. I think it starts with communication and focusing on ways we're going through this process. We really changed the framework of meaningful use and talked more about meaningful outcomes and sort of how meaningfully using the system will lead to the improvements in safety, the improvements in quality, the improvements in outcomes and giving providers and clinicians concrete examples of how this is making health care better, how it's improving the health of our population.

And I think it was very important what we did in terms of structuring the program and focusing on specific areas, including consensus building, reaching out to not just physicians but everyone in the clinical workflow [so everyone] had a voice in the way that their electronic documentation process was changed and also how it was designed to improve the health of the patient. So we established a governance structure, which was very important with bringing everyone on board and helping with the decision-making process. And another very important aspect is the data and making sure that we have accurate data that we can feedback to clinicians about their progress towards meaningful use and meaningful outcomes. We found that providing real-time data helped to really drive behavioral change. So there were many areas of success because of the way that we structured and framed the concept of meaningful use.

iHealthBeat: You mentioned that although the workflow redesign for achieving meaningful use has worked really well in some areas, it's been challenging in others. Could you elaborate more on why it's been so challenging in certain areas and what can be done to address some of those challenges or alleviate some of those burdens?

Mason: I would say with specialists, really making sure the workflow of specialists is considered within the workflow redesign for meaningful use. Really engaging the specialists in the process and really working towards designing a new workflow for them that makes sense for the way that they practice and for the way they communicate with primary care. That's one of the areas that I've spent a lot of time in making sure that I was getting all of the feedback necessary to make changes that made sense for both primary care and specialties.

iHealthBeat: You've led multiple EHR implementations at this point. If you were speaking to a small hospital or physician office that was just getting started with implementing an EHR system or that has been working on it for a while but just struggling, what would your advice be? What are the keys to a successful EHR implementation?

Mason: I would start with saying to develop an engagement strategy that includes physicians from the front lines. It's very important that you pull providers away, and it's very difficult to pull those providers who are usually the busiest, that have the most time dedicated to direct patient care, to get their feedback and their input on the design. I would say to not rush that process and to engage not just the physicians but everyone in the clinical workflow to assess the nursing, the administrative [and] the clinical workflow, how it was done on paper and not to forget how it was done on paper as we design the process for making it electronic. In many cases, I saw that that was a challenge where everyone thought that you had to redesign everything from scratch, but ... following the best practices of electronic workflow is very important.

Training is another important aspect -- developing a training program and making sure that everyone is well trained on how to use the new system. Another point is [to] think about data and reporting early in the process. It's very important that the creation of the needed reports [and] the creation of specific dashboards with benchmarks is considered early in the process and not later.
I would also add that it's a continuous process and quality improvement project. It does not end with implementation. Optimization following the implementation process is just as essential as the structure and the focus and the energy that went into the initial process.

iHealthBeat: How do you plan to leverage your experience and background in public health in this new role?

Mason: I would say my background in public health helps in taking a community-based approach to health and understanding a broader definition of health and the different factors that impact one's health and how those social factors in many cases be incorporated into an electronic workflow design that can create actionable steps to address issues that might underlie someone's chronic medical condition.

It's very important to really understand the context in which patients live in order to provide adequate and quality health care. So I really think that my public health and my population health-based experience -- in addition to the data gathering aspect of that, making sure data is available from a population perspective -- is the way that health care is moving. And I have a lot of experience in that area and really want to bring that into the ONC and my new role as an area of focus.  

iHealthBeat: Fast forward a year to March 2016. What do you hope to have accomplished during your first year at ONC?

Mason: As I mentioned, early in my career and throughout, the physician documentation process and workflow efficiency, usability, simplifying the process and making it smarter and safer is one of the things that I'd like to bring a focus and a spotlight to the ONC and nationally as I start my role here.

I also have a passion for consumer engagement and I want to also make sure that I'm bringing a focus to being able to access their information when and where they need it, at the time they need it. And figuring out the best way to translate information to patients so that it's meaningful to them.

Those are two major accomplishments that I would like to see in my first year.

Source: iHealthBeat, Monday, March 30, 2015

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