May 31, 2012

Tom Sullivan, M.D.

How Often Do You Get Personal Invitation to a Private White House Colloquium?

How often do you get personal invitation to a private White House Colloquium?
Whatever is your answer, for this author it was an exciting surprise and a unique opportunity to walk into a historic building adjacent to the President’s official residence – the Eisenhower Executive Office Building in Washington, DC, and to meet and speak with some high level administration officials.

Eisenhower Executive Office Building
Source: Official White House photo

For me personally, I felt it was, in part, a form of acknowledgment for the work I have done in patient care and organized medicine over many years.  In addition, it was recognition for the accomplishments of the leadership and team at DrFirst in launching the first pilot program for Electronic Prescriptions for Controlled Substances (EPCS) over four years ago.
President Obama has endorsed and placed a high priority on a program entitled the “National Strategy for Trusted Identities in Cyberspace” (NSTIC). The vision for this program is that “individuals and organizations utilize secure, efficient, easy-to-use, and interoperable identity solutions to access online services in a manner that promotes confidence, privacy, choice, and innovation.”
Two weeks ago, I was part of a panel of experts in Scottsdale, AZ presenting some emerging solutions to satisfy stringent DEA requirements for EPCS related to “identity proofing” physicians and other prescribers who want to send ALL prescriptions online, not just the “legend” drugs that are most commonly prescribed throughout our country.
The conference sponsor in Scottsdale was Experian who, along with Symantec, have partnered with DrFirst in providing an online solution to assure we comply with the DEA rule to verify the identity of the prescriber in a manner that is consistent with the appropriate security level (Level 3 out of 4 levels) as defined by NIST – the National Institute of Standards and Technology.  The rule also stipulates that we supply the clinician with 2-factor authentication, which in our case is a “hard token” that serves up a one-time password (OTP) with a lifespan of 30 seconds. This represents one type of “two factor” authentication (what you know and what you have) that makes the security level stricter than just “what you know”.
I mentioned during my brief presentation that I am the Chair of the Confidentiality and Security Steering Committee at Partners Healthcare in Boston, and a past president of the Massachusetts Medical Society. I also pointed out that for more than one hundred years, my society did the “identity proofing” and licensing of physicians, and helped to create the oldest state Department of Public Health, which now does the licensing in Massachusetts. Right after the presentation, one of the audience members suggested DrFirst could help the NSTIC program, particularly in the healthcare space.
Many business process experts, technology companies, and successful entrepreneurs outside healthcare think that our industry—our physicians, nurses and other caregivers—are technophobic and resistant to change. They don’t understand why change comes slowly in our field. Most of these experts gain new insight after being exposed to the complexity of our products and services and the diversity of our patients’ individual situations. In reality, physicians are quick to adopt technology that has been proven to help their practices and their patients, but information technology is still the promise without the proof to many caregivers.
Healthcare is not like any other profession or business. The caregiver-patient relationship is supported by trust more than any other profession. To most physicians, “Trusted Identities in Cyberspace” conjures up a high-tech and somewhat impersonal or dehumanized description of the interactions we experience daily with our patients. And yet, to move forward in the 21st century of the complicated and ever-changing human condition where “Population Health” rather than the care of the individual is becoming the accepted measure of outcomes and appropriate reimbursement, we recognize the need to adapt.
The NSTIC colloquium was held in the historic Indian Treaty Room, a two-story marble-linedspace where the president and many dignitaries continue to hold press conferences and meetings. The grandeur of the room and the French Second Empire exterior architectural style lend an atmosphere of gravitas to any gathering of ordinary mortals who happen to be invited.

Indian Treaty Room
Source: National Archives and Records Administration

My colleagues and I at DrFirst have offered to volunteer our expertise and time to the president and his cabinet, particularly those involved with this program, to help achieve their goals.
We are encouraged by the NSTIC vision, fully recognizing the difficulty presented by the healthcare profession. Physicians are often frustrated by the many rules, regulations, and litigious societal climate that present barriers to productivity and efficiency. Nevertheless, we will collaborate enthusiastically with anything that adds real value to the health of our patients and respects the dedication and services we contribute.
Finally, although as I said, I am very supportive of these technology initiatives, I have mild anxiety over the pundits and policy wonks who are unfamiliar with the healthcare workflow, but who are in charge of changing the way we practice medicine. So in conclusion, here is a little advice from someone with 40 years of patient care experience:
Everyone is familiar with the ancient first rule of Medicine:
“Primum, Non Nocere” (First, Do No Harm).
To that hallowed rule, I would respectfully add:
“Secundo, Propera Ne Me” (Second, Don’t Slow Me Down)

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.