As a medical officer and the medical director for patient safety in ONC’s office of policy (OPOL), David advises ONC on what it can do to improve the safety and safe use of health IT. He also helps his colleagues in OPOL understand how ONC’s work may affect practicing clinicians.  

1. Tell us about some of the projects or initiatives that you lead.

One project I help lead is our work on the Safety Assurance Factors for EHR Resilience (SAFER) Guides, a set of nine documents with recommendations health care providers can use to improve the safety and efficiency of electronic health records (EHRs). Since the guides were first published in 2014, they have been a widely accepted, practical resource that hospitals, clinics, and both large and small practices can use. With so many different EHRs available, the SAFER Guides are a unique, authoritative resource of recommendations, beyond the provider’s EHR manual, to guide how to safely set up, maintain, and operate the EHR.

I am also involved in our work to improve the equity of our health care system—in this case using health IT. Our national coordinator, Micky Tripathi, coined the compelling term for this work, “health equity by design” (HEBD). We all recognize the tremendous impact and potential that information technology has in health care and the goal of our work in HEBD is to leverage that potential to correct some of the systemic inequities of today’s health care system. Led by ONC chief medical officer, Dr. Tom Mason, the HEBD team recognizes that to be most effective, considerations of equity must be baked into health IT systems, not bolted on as an afterthought right before the system is ready to go to market.

2. What led you to your career here at ONC?

While practicing surgery, I began my federal career at the Centers for Medicare & Medicaid Services (CMS) in the quality improvement group where I designed and implemented the Surgical Care Improve Program (SCIP). I also was fortunate to design, implement and run the Medicare Patient Safety Monitoring Program (MPSMS), the largest and most comprehensive national assessment of patient safety in hospitals in the country. Both programs relied on chart abstraction from paper-based records, an expensive and ultimately unsustainable method if we wanted to expand or fine-tune any of the measures. It was clear to me that the path to long term quality and safety measurement required automated data abstraction from electronic medical records. In October 2007, I had the opportunity to join the still relatively new ONC to focus on health IT adoption. Long before the HITECH Act incentives jumpstarted EHR adoption, my team led programs and policies to encourage EHR adoption. The potential for electronic data collection for the measurement of quality, safety, and equity remains the most exciting aspect of our work at ONC.

3. What are some skills or strengths that you contribute to your work at ONC?

My experience, knowledge, and continued insight into the day-to-day operations of medical practice and the concerns of practicing physicians is my greatest contribution to ONC. That clinical expertise is tempered with almost 50 years’ experience in nearly all facets of software development, from programmer to systems analyst and on to automated testing.

4. What is something you’ve accomplished at ONC that you’re most proud of, and why?

My finest accomplishment at ONC has to be the long-term growth and acceptance of the SAFER Guides, which are now important elements of the CMS quality program for both hospitals and ambulatory care practices.

5. What would you say is the best or most interesting part of working for ONC?

By far, the best and most interesting part of working for ONC is the opportunity to work alongside some of the finest, most hard working, and brilliant people in health care.

6. How would you characterize ONC’s success?

ONC is successful because we have supported American health care’s transformation from paper-based patient care documentation – with all its inherent shortcomings – to digital record keeping with all the associated potential improvements in quality and safety.

7. Tell us about a project you are currently working on and how it fits into ONC’s mission.

Beyond my current work with clinical insight in the development of policies and regulations, I am most excited about our work to curate and improve the SAFER Guides—a key component of our ONC health IT safety work.

8. What are the core values of ONC that are important to you?

The core value that is most important to me is embodied in our vision, “Better health enabled by data.” At the end of the day, I am a physician committed to the care and well-being of those we are honored to serve. Improving that service using information technology is the core value most important to me.