DR. WILLIAM WINKENWERDER, JR. Chairman The Winkenwerder Co. LLC

Biography

Panelist Perspective

Biography

Dr. Bill Winkenwerder is one of the most influential and recognized leaders in American healthcare.  He is the Chairman of The Winkenwerder Company, a healthcare consulting and advisory company based in Alexandria, Virginia.  He is also a board director and advisor to several companies.  He also speaks throughout America on health issues.
Dr. Winkenwerder’s experience both as an health industry leader and also as a senior government health leader is unique.  From 2001 to 2007 he was the Assistant Secretary of Defense for Health Affairs; before that for over 15 years he served in leadership positions at Blue Cross of Massachusetts, Prudential Healthcare, and Emory University.

As a major Washington policymaker, senior business executive and former practicing physician, Dr. Winkenwerder is known as a thought leader.  He was an early advocate for preventive healthcare, evidence-based medicine, and electronic health records.  He has overseen major programs to improve quality and reduce healthcare costs, and worked closely with many of America’s major employers on their health issues.

At the Department of Defense, Dr. Winkenwerder was the leader of the Military Health System (MHS) with a $40 billion annual budget, and the principal medical advisor to the Secretary of Defense.  The MHS with 132,000 personnel, cares for 9.2 million people through a national network (TRICARE) of physicians and hospitals, and 70 military hospitals worldwide.

During his tenure, he led groundbreaking advances in battlefield medicine and implementation of the world’s largest electronic health record system (AHLTA). He also brought many innovations and improved business practices to government, improved TRICARE and mental healthcare for soldiers, oversaw medical relief efforts for the Asian tsunami and other disasters and led preparedness efforts for a possible avian flu or biological attack.  He worked closely with the National and Homeland Security Councils and with leaders throughout the Cabinet.  He has been a key proponent of the goal of developing electronic medical records for all Americans.

Today, Dr. Winkenwerder and his company provide strategic advice to some of America’s leading health companies and work to identify emerging transformative companies and technologies.  He also strongly advocates for better controlling the enormously growing federal health budget, engaging individuals and consumers in their healthcare, and improving public health.  He serves with unique understanding at the interface of government, public policy, and the private sector.

A graduate of Davidson College and the University of North Carolina School of Medicine, Dr. Winkenwerder is board certified in internal medicine and received his MBA from the Wharton School.  He has written extensively about health issues and appeared frequently in the national media and before Congress.  Deeply committed to improving and reforming health care in America, he is a true visionary leader whose views are widely regarded.

Panelist Perspective

Challenges for Health Information Technology to Improve the American Healthcare System

Never has there been more excitement about the potential benefits of digitizing the American healthcare system and implementing universal electronic health records.  As a physician and former private sector health executive who also has lead one of the world’s largest healthcare systems (the US Military Health System), few have been stronger advocates than me over the past decade for the pursuit of digitizing health records and automating key aspects of our healthcare system.  I believe there will be benefits for all that include reductions in costs, enhancements to quality, improvements in access to care, fewer errors, and greater consumer satisfaction.

However, I also believe the purported benefits to our healthcare system of universal electronic health records – especially the huge projected savings to growing national health expenditures – are greatly exaggerated.  Further, I am deeply skeptical of the federal government’s ability, even with the cooperative support of the private sector, to achieve the goals and timelines that have been established by Congress and the Obama Administration.  These goals are extraordinarily ambitious and unrealistic.

Why am I skeptical?  How will the transformation take at least twice as long as projected?  There are four reasons.  They relate to technical, cultural, privacy and governance challenges.  Each is a mountain to climb in its own right.

The technical challenges are probably the least difficult.  Nonetheless, they are quite formidable.  First is the creation of universal data standards that cover the massive and complex language terms of medicine and that will allow for exchange of information between and among disparate clinical information systems.  There is also the sheer difficulty of creating and managing the data exchange platforms and gateways that are required to move so much information 24 hours a day, 7 days a week, 365 days a year, securely and accurately.  Few prototypes exist now and those that do are still in early stages of development.  No businesses have yet made money in health information exchange.  A lot of work remains to be done.

Cultural obstacles relate to the ability and willingness of physicians and other care providers to change the way they care for patients – what is called the process of care.  I have had a lot of experience with this issue.  What I have learned is that there is a big difference between physicians saying they are open to altering their habits of clinical documentation and recordkeeping and physicians actually making such changes.  It is a total change in the way one practices medicine.  A lot of initial training and ongoing support is needed.  This aspect seems to have been overlooked in planners’ minds.  Who is going to provide this assistance and how will it be paid for?

Each of us has an expectation that our medical records will always be kept private.  We should never change this point of view.  On the other hand, to make full use of the ready availability of online medical records requires that many people have access.  Each of our 50 states as well as the federal government sets rules for privacy and security of medical information regulating such access.  Harmonizing these rules is an enormous challenge.  There are determined and emotional voices on several sides of the privacy debate.  Settling these issues will not be easy in a way that supports the vision of seamless universal access to personal health data.  I see a process that could take years to unfold or that could be stopped in its tracks by a single court case or calamitous event.

Finally, there is the matter of governance.  What do I mean?  I mean who decides the policies that relate to technical, privacy, and cultural (adoption) questions, and who is responsible for local, regional, and national health information networks?  It is not that such questions have no solutions.  They do exist.  New governance mechanisms have begun to emerge and develop.  But such decision making processes take time – many years – to develop in a way that establishes and maintains the trust of all parties – doctors, administrators, payors, policy makers, and most importantly patients.  What I am talking about is called massive change; the change that works requires buy-in and support and time.

Finally, there is the matter of hoped for savings.  RAND in 2005 published a study already widely discredited that claims there could be as much as $80 billion in annual savings.  On the other hand, a spokesman for HHS and Dr. David Blumenthal, the new head of health information technology, recently put the number at $12 billion over 10 years, which is less than is being spent under the recent stimulus package.  I do not know what the actual savings number will be.  I hope it will be at least 2-3 times the $12 billion figure.  But such savings are hard to measure.  Policy makers would be foolish to count them against new spending to extend health insurance coverage.

If it seems like my purpose here has been to raise a bunch of thorny and difficult issues you would be correct.  That is the reality ahead that I see.  It does not mean we are stuck and should not move forward.  But the sooner we all embrace reality and get to work on it, the more likely we will see the vision of a digitized healthcare system and whatever benefits it will ultimately yield.