The primary focus of CHIME’s Advocacy Program is advance the role of CIOs and senior healthcare IT leaders by providing educational, collaborative, and advocacy programs to improve the quality of care. Through CHIME Policy Chats, healthsystemCIO.com is partnering with the organization to provide a forum to educate CIOs on advocacy efforts, learning opportunities, updates on legislative and regulatory issues, and other relevant topics. Featured in the discussions are Sharon Canner, senior director of advocacy, and Jeff Smith, assistant director of advocacy for CHIME.
In this segment:
- Recapping the Fall Forum
- Responding the request to delay Stage 2 payments — “It’s quite important that the money keeps flowing”
- Educating politicians about MU
- Urging Stage 3 comments
- Searching for a CEO to represent CIOs
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There has been a lot of work done by the federal policy committees, the Health IT Standards Committee and the Health IT Policy Committee to bring in the input of the providers, the consumers, and the states. All that work will go forward. I think that’s a real plus for health IT.
Basically what we said to them was while we share your concerns with the current state of interoperability, we strongly believe that the EHR incentive program under the policy of Meaningful Use has been essential in moving the nation’s healthcare system into the 21st century.
We think that with those incentive payments stopped, you’re going to really put a stick into the cogs on some of these things, and so it’s quite important that the money keeps flowing.
Some of the new capabilities that this request for comment has suggested do not exist currently, and certainly the workflows surrounding that technology don’t exist. So it’s really incumbent upon organizations like CHIME to make sure that their voice is heard.
Having the voice of the CIO being the boot on the ground that’s actually having to do all of this is going to be invaluable — not only for the Health IT Policy Committee, but also ONC and CMS as a whole as they work to develop a much more comprehensive notice of proposed rulemaking.
Gamble: Hi Jeff and Sharon, thanks so much for taking the time to join us for healthsystemCIO.com’s inaugural CHIME Policy Chat.
Canner: Great, we’re delighted to be with you.
Gamble: Okay. Why don’t we start with the 2012 CHIME Fall Forum, which was held in late October. What are some of the most important elements that came out of the conference in terms of advocacy events and opportunities for CHIME members?
Canner: Let me start by mentioning a couple of things. I think one of the key sessions that I would point to was called, ‘Linking Stakeholders Toward Interoperability.’ It was an opportunity to feature the EHR/HIE Interoperability Workgroup, which, as many people know, is now a 15-state effort to enable health information exchange to stand up the same protocols. The intent of the session really was to inform CHIME members but also to get them much more involved with this effort. I think they are involved more extensively in some areas.
One of the speakers were Dave Minch, who is the President and COO of HealthShare Bay Area and is the leader in behalf of California and he works with a number of the other states. The CIO speaker was George “Buddy” Hickman, who is EVP and CIO of the Albany Medical Center in New York. And of course, New York was the founding member of the Interoperability Workgroup. It was a very good dialogue around particular issues with connectivity.
Another session included the key policymakers from the federal level. Dr. Mostashari, who of course is the national coordinator [for health IT] of ONC, was the keynote. He was then joined in a later session by two of the regulators: Steve Posnack with the ONC and Travis Broome from CMS. This was really a very interesting dialogue with about two minutes of comments by both Steve and Travis at which time CHIME members jumped in with questions on the stage 2 rules. So it was a very good exchange of information.
An additional session was on StateNet, which is the CHIME effort to connect stakeholders within various states. Just by way of background, CHIME includes about 600 participants, not all CHIME members of course, but these are stakeholders and there was just an online platform to dialogue around various issues. That was the second session.
But I would just say that it was really a great opportunity for CHIME members to talk about state issues and how that intersects with the federal sphere. So I think that probably rounds out my response to you on that first question.
Gamble: Let’s talk a little bit about the 2012 election. How do you think that the results will impact the advancement of health IT initiatives?
Canner: I think as a basic statement, I would start off by saying that health IT has been bipartisan going way, way back for a number of years. But currently, the election results mean that the groundwork that has been laid by the HITECH Act and by Meaningful Use will go forward. Certainly we’re now in Stage 2, looking at Stage 3. So the work that has been done on certification, on standards, and on the Standards & Interoperability Framework — that will go forward.
There has been a lot of work done by the federal policy committees, the Health IT Standards Committee and the Health IT Policy Committee to bring in the input of the providers, the consumers, and the states. All that work will go forward. I think that’s a real plus for health IT.
Gamble: As you know, there were a few Republican house members who requested to delay the Stage 2 payments for Meaningful Use. What is CHIME’s position on this? Is this something that CHIME commented on?
Canner: I think I’m going to ask Jeff to talk a little bit about those letters and the action that CHIME took going back to October.
Smith: Yeah, certainly. So it was in October when Energy and Commerce and Ways and Means and their respective health subcommittees basically sent a letter to the secretary asking her to stop the incentive payments. Their concerns were basically twofold. They thought that there wasn’t enough demonstrated interoperability, and they were concerned that the incentive payments and the underlying regulatory infrastructure that we know as Meaningful Use weren’t really pushing the ball on interoperability far enough and fast enough. So basically what we did was circulate some sign-on letters of CHIME members to those congressmen who resided in Michigan, Pennsylvania, and California. Basically what we said to them was while we share your concerns with the current state of interoperability, we strongly believe that the EHR incentive program under the policy of Meaningful Use has been essential in moving the nation’s healthcare system into the 21st century.
We also pointed out and basically tried to acknowledge their concerns about interoperability. We said that we too have fiercely advocated, as CHIME, for more standards to enable greater interoperability, and we pointed out that Stage 2 actually has some of these standards in it in regards to transport standards, content standards, and vocabulary standards. Those are things that were not in Stage 1, but are in Stage 2. And we do think that’s going to have a substantial impact on interoperability.
We also did touch upon just the financial aspects of the incentive payments. While certainly the incentive payments don’t cover the full depth and breadth of what it takes to implement an EHR system and to meet all the criteria for Meaningful Use, the payments are absolutely necessary to have. With a lot of the endeavors and projects you wouldn’t be able to sell the board on it unless you had these incentive payments as a backstop. So we think that with those incentive payments stopped, you’re going to really put a stick into the cogs on some of these things, and so it’s quite important that the money keeps flowing.
And finally, we made the point that we are truly in the early stages of really what is one of the fastest transformations of any industry in history. And without the incentive payments and the policy platform that is Meaningful Use, this transformation is greatly jeopardized.
Gamble: One thing I think that came out of that is that it did generate some discussion and maybe did perhaps kind of served to educate some of the politicians a little bit more about Meaningful Use. So you could see that as a positive.
Smith: Absolutely. And I think to the earlier question about the results of the 2012 election, while it breeds some level of stability for what’s going on in the executive branch at HHS, it also serves as an opportunity for those of us in the health IT world to educate new members and even revisit folks who have been important allies in the past. I do think that there’s some education that has resulted from those letters and it started a conversation on the hill that we’re likely to see continue on into the next congressional class.
Canner: It’s a healthy conversation; I will indicate that. I think it may be that the Congress is not that well-educated on exactly what the federal investment has been and being able to realize the federal investment as well as the private sector investment. It will take some time. The industry is growing. There have been a lot of successes and there are a lot of good models out there. It will be important just to build a much better understanding of exactly what is happening on the ground.
Gamble: Right, certainly things are progressing. It’s funny to even be talking about Stage 3. It seems like it’s been going so quickly. So the Stage 3 recommendations were recently released. Are we into the public comment period at this point?
Smith: Yes. The clock has started to tick and we have until about the middle of January.
Gamble: Okay. I know that there are CIOs who are active participants and will provide input, but for those who maybe haven’t, can you just kind of talk a little bit about why it is so important to get that input from those who are implementing these technologies and who are in the middle of everything?
Smith: Absolutely. I think what’s important to note about where we’re at in the scheme of things is although Meaningful Use Stage 3 is scheduled to go into effect in 2016, right now the request for comment — what that instrument does is it really is the opening gambit in deciding what Stage 3 will look like. Now for stakeholders at the federal level and stakeholders that work through CHIME or individually through their hospitals, one of the tough aspects about all this is that they have to really kind of project themselves into the future and really try and imagine what the health IT landscape will look like. And given how fast moving health IT and the technology and the process and the workflows are all developing — that’s a real challenge.
But one of the things that we try to stress to those as they’re thinking about maybe helping to craft the comments is that because we are in such an early stage, the policies are in a very formative state of being right now. So for those CIOs who know what it’s like day in and day out — for them to lend their voice to the realms of possibility is key, because that’s really what we’re talking about. Some of the new capabilities that this request for comment has suggested do not exist currently, and certainly the workflows surrounding that technology don’t exist. So it’s really incumbent upon organizations like CHIME to make sure that their voice is heard. As we go through this request for comment (RFC) and as we start to build work groups, we’re really going to be looking at what’s in the RFC as well as what’s not in the RFC as a means of trying to leverage the expertise and the experience of some of our members.
To that point, we are in the process of setting up two work groups. One of which is going to be focused on the measures and objectives of Stage 3, and then the other one is going to be focused on the clinical quality aspects — the clinical quality measures (CQMs) and the associated questions around that. Because again, as you can imagine, the CQMs are an incredibly difficult and complex area especially when it comes to policy making and how you integrate policies with practice. So what we’ll be focused on there is projecting the industry as a whole into the future about four years to really figure out what’s feasible, what’s not, and how to move forward.
Just as a quick kind of example of one of the things that we’re looking at, one of the items in the measures and objectives part of the document would have immunization registries basically send the data from the registry to the EHR for 30 percent of patients. For those who are currently meeting Stage 1 or preparing for Stage 2, thinking about what it would take to get your state’s immunization registry to submit data into your EHR, I think you would probably – you’d have to kind of have your palm and your forehead meet. Because you’ve got a situation where states are struggling right now to accept electronic transmissions from hospitals, let alone send histories back to the hospitals.
You have some really practical challenges associated with that, the least of which is basically patient data matching. Being able to have the registry send immunization data for one patient and have that seamlessly integrate into a hospital EHR would portend a level of patient data matching that is rare if not elusive at this point in time. There are a lot of those kinds of things that we’re going to be looking at, and having the voice of the CIO being the boot on the ground that’s actually having to do all of this, is going to be invaluable — not only for the Health IT Policy Committee, but also ONC and CMS as a whole as they work to develop a much more comprehensive notice of proposed rulemaking sometime next summer, which is when a lot of that information is going to start to coalesce.
Gamble: It’s strange to be thinking about three to four years out, but you have to be doing that. It’s essential to do that.
Smith: Exactly. And one thing that I think is interesting is when you talk about why are we doing this now and why are we moving so quickly, to be honest, the simple reply from ONC and from CMS is, ‘we’re doing it because you told us we had to do it.’ Truth be told, a lot of folks, including CHIME, looked at the timeline for Stage 2 and said, ‘this is just not feasible. We can’t develop all of the standards and protocols that are needed and then test it, implement it, and develop workflows around it in that amount of time.’ Delaying Stage 2 by a year was a direct result of a lot of that criticism and so, like you said, it’s a difficult task to do, but it’s one that given the nature of things, we have to contend with.
Gamble: It’s interesting that you brought that up, because in an interview we just published on our site with Wes Wright, who is CIO at Seattle Children’s Hospital, said that the government, with the help of organizations like CHIME, is taking the CIO’s input and actually listening and responding. And he used as the example ICD-10. So that’s a whole other interesting component — that sometimes there are things that are already in motion that can be altered if enough CIOs give their opinions and give the time to talk about their experiences and why they think this needs to be done.
Canner: It really brings us around to one of the important questions and directions that CHIME is taking by hiring a CIO to be CEO of the organization. And the real reason is having the voice of the CIO; having that person much more out in the public space. We’re excited. The announcement was made about a month ago that CHIME is recruiting a CIO to be CEO. The new individual will probably be announced in February, we anticipate. The reason, as we just articulated, is really needing to have that person very much out in front.
Health IT is revolutionizing the healthcare industry — not as a means itself, but it is really the tool that is going to change and transform the delivery of healthcare to get more value of what we are spending on healthcare as a nation. We’re very excited about this new change in leadership, and we’ll be working with that person directly as part of our efforts on public policy here in Washington. We’re really delighted that we can talk with you, Kate, and we know that a lot of our members are a good part of your audience. So I think this has been a really good conversation. If there are any other points or anything else that we can add, we’ll be glad to do so.
Gamble: I really appreciate both of you taking the time. I think the last thing I wanted to ask was about StateNet. Are there any updates or calls to action that you have for CIOs in terms of the site?
Smith: Yeah, absolutely. I think as far as StateNet is concerned, we had a really great conversation with members of StateNet and CHIME members in particular at the Fall Forum. We really tried to hone in on what does 2013 look like? What are the major challenges that are really those policy issues that are centralized at a state level that are in need of collaboration and cooperation across state boundaries?
Right now we’re really in the process of developing a draft roadmap that contains not a high number of issues, but some really important issues such as health information exchange, consent policy, and patient data matching. We’re really trying to focus on those areas where we can disseminate best practices and technical standards, and really put a spotlight on some of the innovation that’s out there. So I would just say as we get closer to the end of the year, we’re really going to start putting a lot more detail into this roadmap and trying to get both CHIME members and stakeholders in the broader health IT community together through various forums and online tools. It should be something definitely to look forward to, and I hope that moving into next year, we’ll have some definite calls to action and we’ll have some more updates on the StateNet front.
Gamble: Okay, great. Unless you guys have anything else, I think that that’s given us a great overview, and I really look forward to speaking with you guys again.
Canner: Great, thank you. It was our pleasure.
Smith: Thanks, Kate.
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