So what is an anesthesiology critical care specialist with over 30 years of clinical practice at a highly regarded academic medical center doing as the ONC’s chief medical information officer?  The answer includes direction from Dr. Jack Wennberg, pioneer researcher in medical systems and founder of the health services research group that is now best known for the Dartmouth atlas, followed twenty years later by the same but much clearer advice and direction from former Surgeon General, Dr. C. Everett Koop before he passed away – “you have done all that you can accomplish here and now you should devote time and energy to government service”.

As the physician leader of the multidisciplinary intensive care unit at Dartmouth I was struck by all of our physiological measurements, which seemed to grow at an endless pace as we adopted more & more technology. Lost in a sea of numbers was good science about their utility, outcome data about populations of patients, or which of our many therapies were effective. A desire to learn from each clinical encounter inspired in me a desire to automate the care processes in critical care to improve our quality, outcomes, and help guide patients and their families through the high tech maze of ICU care. My proposal to leadership to automate the ICU in the late 80’s wasn’t funded but it led to a senior institutional role in health IT, initially as a one-year leave of absence from the ICU.

Twenty years later after first moving our institution away from an early version of developed software, followed by a very successful twelve year run of incrementally developed, widely deployed, highly regarded, enterprise-wide homegrown EHR, and finally a transition to a widely used vendor system I departed my home and home institution for a one year tour in DC as a Robert Wood Johnson health policy fellow. I was privileged to work for Senator Orrin Hatch in his personal office covering the health IT portfolio and participating with the Finance and Health, Education, Labor, Pensions (HELP) committee’s professional staff. We held two health IT hearings during that summer during which I was impressed at how health IT was a truly non-partisan issue. I met with countless health IT stakeholders – from individual clinicians to large associations and interest groups. Many of these stakeholders expressed frustration with their clinical systems as well as the complexity of the regulatory and reimbursement systems that demand their attention. I decided to try and stay in government to continue to work on these issues but also to work towards a health IT enabled learning health system – a goal I first envisioned in the mid 1980’s. I was fortunate that a position was available at ONC to allow me to do that and to lead the Office of Clinical Quality and Safety (OCQS) in addition to being appointed ONC’s CMIO.

Our office (OCQS) is a team of talented and highly regarded clinicians with extensive experience using health IT software in a variety of settings – we are doctors, nurses, pharmacists, and public health experts. All of us are dedicated to improving the safety and quality of health IT and using it to improve the overall safety and quality of clinical care.

In the coming months expect commentary on issues in which we have a particular interest: the quality and effectiveness of clinical documentation; identity management – a fundamental problem to be addressed in a nationwide interoperable health IT universe; the tyranny of cut and paste, copy forward, and other vagaries of our current systems; practicing safe health IT.

I, and my colleagues, Dr. Michael McCoy and Dr. Thomas Mason, look forward to hearing your thoughts and reactions to our collective work and that of our agency.