View from the Top: An Interview with Dr. Robert Wah
As both president of the American Medical Association (AMA) and chief medical officer at CSC, Dr. Robert Wah occupies a unique position at the intersection of healthcare and IT.
In addition, he lends both organizations a perspective on women’s healthcare, with a specialty in obstetrics, gynecology and reproductive endocrinology. He also brings a perspective on military medicine after 23 years of active duty service in the Navy and roles as vice chairman of the Navy's largest OB/GYN program and associate CIO for the military health system. In Health IT, he was the first deputy national coordinator and chief operating officer, starting up the Office of the National Coordinator for Health IT (ONC) at the U.S. Department of Health and Human Services.
Plus, Dr. Wah is blazing trails as the first Chinese-American president of the AMA, the nation’s largest physician organization. CSC World’s Jeff Caruso recently caught up with Dr. Wah to talk about the challenges and opportunities in healthcare IT.
What are your top objectives at the American Medical Association?
The organization has three major focus areas: to improve health outcomes for our patients, to improve professional satisfaction and practice sustainability for our physicians, and to improve medical education for the doctors of tomorrow.
In the area of improving health outcomes, we chose to go after high-profile diseases that are affecting many millions of our patients and costing us billions of dollars. We've focused on keeping people from converting from prediabetes to diabetes. We set up a program where physician offices can now refer their prediabetes patients to the YMCA, where they are using a CDC-developed program that is 71 percent effective in helping patients stop from progressing from prediabetes to Type 2 diabetes. Since the YMCA is often in the neighborhood where the patients live, it's very convenient for them to go there and then the patient, the YMCA and the referring physician are connected.
In the area of cardiovascular disease, there are 30 million patients in the United States who see a doctor on a regular basis and still have uncontrolled high blood pressure. We've teamed up with major academic centers, such as the Johns Hopkins Medical School, in introducing a program called Measure, Act and Partner that's been very effective in helping patients get their blood pressure under control.
In terms of improving professional satisfaction and practice sustainability, we did a study with RAND Corp. that found electronic records were a major source of dissatisfaction for physicians. They don’t want to stop using electronic records, but they want to make them more useful as a tool to help them take better care of their patients.
We've been addressing that through a workgroup in which we convened practicing physicians and health IT experts to come up with the eight factors we would ask for from health IT and electronic health records (EHR) vendors to make the electronic health record more usable.
In improving medical education for tomorrow's doctors, two years ago we set up a grant process through which we gave out $11 million in grant awards to medical schools that are doing medical innovation projects. This started an excellent conversation about how we can improve and innovate the medical education process for our doctors of tomorrow.
How does your AMA work line up with your role at CSC?
They're very much complementary. My opportunity and my privilege at the AMA is to see healthcare from a very good vantage point as president, and that means I get to talk with patients, physicians, policymakers, lawmakers, payers, hospitals and other organizations about how we can work together to improve healthcare.
At CSC, I provide a clinical perspective on all the great IT work we're doing around the world, again by bringing technology in to help doctors take better care of patients. That clinical perspective I bring is enriched by the observations and conversations I have as AMA president.
What are the most pressing issues that the e-health community needs to address?
We have to make sure that as technology is developed and deployed, it is in line with the top-line goal of improving the care for our patients, and that it isn't a hindrance or an obstruction to getting to that goal.
Some of the things that we talk about, both at CSC and the AMA, is how do we make technology more agile so it can be complementary to the workflow and the business process of how we take care of patients, and how do we improve the usability of the IT tools.
We've also seen a great interest from patients who want to engage in their own healthcare. One of the ways they want to engage is having better information so they can make better decisions. By moving to a digital platform, we can offer them new opportunities and new tools to engage in their healthcare so they can help to improve it.
You're known for the phrase, “Better information for better decisions.” How is the provider community progressing in that area?
Everybody in the healthcare world will make a better decision with better information. Patients will make better decisions about their health, as will doctors, hospitals, insurance companies, governments, researchers and others in the healthcare arena.
It's the role of the technology to deliver the right information to the right person at the right time and the right place. It's not as if IT is going to help us craft a new way to do heart surgery, but it will deliver better information about the outcomes of the last 1,000 heart surgeries and that will enable us to make a better decision about how to innovate or improve heart surgery for our patients.
What’s an example of where this works well?
At CSC, we built a system for the Department of Defense military health system called the Pharmacy Data Transaction Service (PDTS) with a real-time medication database that covers all 10 million beneficiaries in the military health system. No matter where they get their medication filled, we have a real-time record of that medication.
In the military health system, I haven't written a prescription on a piece of paper in over 20 years. So when I write a prescription for a patient at Walter Reed in Bethesda, when I hit Enter, within two seconds the system goes to that database and checks what I just wrote a prescription for, and it comes back and tells me whether the medication is going to conflict with a patient's allergy or with a medication that patient is already on, or is a duplication of a medication he or she has already received.
It's also prevented abuse of medications like narcotics.
What changes can patients expect in the coming years from advances in healthcare IT?
This analysis of digital information will allow us to create a very personalized treatment for individual patients. In the president's State of the Union this year, he used the term “precision medicine,” where medicine is now targeted specifically for what can help an individual.
The example I often give is when a patient comes in and we find out that they're diabetic. In the past we might have said, “For diabetics, this is what you do.”
But in the future, when we have richer, more specific information about that patient, we can say, “For you as a 32-year-old, left-handed, Hispanic female with the following four medications and the five medical problems that you have, specifically this is what we recommend for your diabetes.”
We're also very excited about the possibility of expanding data analytics beyond just clinical information, taking into account other information about patients and their environment and perhaps predicting and helping them prevent problems before they occur. I see a change in analytics where we go beyond a traditional hypothesis and then “ask the data.” Instead, we will merge structured and unstructured data, and then the data will show us emerging patterns that we would not have thought to ask about.