When CHIME’s Public Policy team made the trip to Washington DC in September for National Health IT, there was a different vibe than in previous years. This time, rather asking for relief or funding, the emphasis was on showcasing the innovative work being done at health systems across the country. For Leslie Krigstein, CHIME’s VP of Congressional Affairs, it was an opportunity to be a cheerleader, and she loved every minute of it. In this interview, she talks about the advocacy work her team is doing, the topic that dominates “nearly every conversation,” and what will be the key priorities going forward.
Gamble: The first thing I wanted to talk about is National Health IT Week, which was held in late September. What was CHIME’s approach with the event?
Krigstein: This year, we wanted to look at the promise of healthcare technology. Too often during the past few years, we’ve been really focused on the changes stemming from Meaningful Use, where we were asking for fixes and asking for relief. This year during National Health IT Week, we wanted to turn that on its head and take the opportunity to showcase some of the great work our members our doing that is innovative and cutting edge, and to celebrate those accomplishments.
We had people come in and talk about telehealth and genomics and how they’re leading the industry in terms of adopting new technologies. So it was a little bit of a different flavor. Telehealth is not a topic we’ve been a leader in, but when we surveyed our members at the end of 2015, it was identified as a top five priority. So it’s something I foresee us becoming more involved with in 2017, and we figured this was the perfect chance to kick that off.
Gamble: What type of format did CHIME use to showcase the organizations that are leveraging these technologies?
Krigstein: We did a congressional briefing and a number of meetings, and we did a briefing in one of the Senate office buildings that was moderated by [CHIME CEO] Russ Branzell. We had Marc Probst, Albert Oriol and Cara Babachicos representing CIOs, and Cindy Cahill — a former CIO who now wears a different hat — offering the vendor and consultant perspective.
Gamble: What kind of feedback did you get?
Krigstein: There has been so much bipartisan interest in Congress — particularly in the telehealth space, so we heard a lot of positive feedback, and that spurred requests to start to quantify some of the results that our folks outlined. The Congressional Budget Office has had so many issues evaluating whether telehealth is costing money rather than saving money, and so CHIME’s Public Policy team is focused on spending time with our members and producing case studies. There are health systems that have the facts and figures to back up savings and care outcome improvements, and we want to be able to use that to pitch to the Budget Office.
It was important that the folks on Capitol Hill recognize that even though we haven’t been as vocal about telehealth in the past, our members are at the forefront of trying to push it through their health systems. So that was definitely a key takeaway.
Gamble: It sounds like the week had a very different vibe this time around.
Krigstein: Absolutely. And of course Meaningful Use and patient identification came up, as well as interoperability, which is going to become more and more critical. So we’re trying to weave all of those threads in, while at the same time highlighting the great work organizations are doing — sometimes in isolation.
It was fun. It’s nice to a cheerleader and a champion, instead of having our hand out and asking for reasonable changes. We were able to put that aside for a bit.
Gamble: And I imagine cybersecurity is a top priority. I attended the session where the Health Care Industry Cybersecurity Task Force gave an update of what they’ve found so far, and it was a packed room. What are you hearing from members regarding this topic?
Krigstein: In terms of CHIME Public Policy activity, cybersecurity has really picked up steam in the past two years, particularly with the launch of AEHIS and the reality that has hit CIOs with breaches. When I look at how I’ve spent most of my time on Capitol Hill over the last 12 months, probably about 50 percent has been devoted to cybersecurity, with patient identification, interoperability, and Meaningful Use filling up the rest of the time.
It dominates nearly every conversation. We’ve seen federal agencies put out so much draft guidance in the past year, whether it’s NIST or the FDA, and there’s only going to be more activity, which I think that’s a good thing. But there aren’t a lot of voices in the healthcare space, and so we’ve spent a lot of time building relationships across the sector and across other industries to figure out how we can help our CIOs and CISOs, both with resources from the federal government, and in sharing insights from our members back to the Hill.
One topic that has come up a lot is medical device security. We believe the FDA User Fee Agreement for devices is a ‘must-pass’ piece of legislation for next year, and we’re taking the opportunity to increase cybersecurity awareness with devices — not as a hard legislative ask, but really as a potential platform to raise the profile.
When the Cybersecurity Information Sharing Act was passed last year, it included a directive that the Task Force was to report back to Congress. And so I think the industry will definitely be watching closely to see what it comes up with, whether it’s industry recommendations or government recommendations, or if it asks Congress to take legislative action. We’re tracking it closely, and I think you’ll start to see a lot more folks weigh in on what they want to see. Education is on the rise and interest is on the rise, which are positive aspects; the negative is that we’re behind the eight-ball. We’re always playing defense instead of playing offense, so we’re trying to see what we can do proactively to provide the right resources and education. And part of that means looking not just at how we can protect devices we’re already using, but also devices that are coming into the market in the future. Otherwise, we’re going to be chasing our tails for years to come.
Gamble: It’ll be interested to see how members rank their biggest priorities at the end of this year.
Krigstein: I think we’ll see a lot of the same issues, but maybe in a different order. One area where we are seeing a shift is in trying to understand delivery system reform efforts better. With such a big emphasis on quality measures with MACRA, there’s been growing concern about reporting requirements. Now that it’s mandatory full-year reporting for clinical quality measures for hospitals, those challenges are really coming to the forefront.
Gamble: When it comes to advocacy, has it been a challenge to recruit CIOs and other leaders for things like visits to Washington DC, participating in panels, or even commenting on rules?
Krigstein: Definitely. When rules come out, they’re thousands of pages long and are not in plain English, and so it takes time to boil that down. From my perspective, I see policy as a value-add to the members. They come to the conferences for education, but when we’re able to push for changes in the reporting period, that can lead to cost savings.
We just want the members to know they can come to us. We do a weekly Washington debrief, and we do a lot of outreach through MyCHIME and as many other channels as possible. Every time there is a comment we have workgroups, but it’s hard to find folks who are willing and able to give an hour a week for a few weeks. We’ve looked at doing short surveys just to take temperatures, and we’ll do one-on-one calls.
We’re also going to introduce Public Policy office hours to make ourselves more accessible. Oftentimes, our members don’t realize we can be a gateway for them to CMS or ONC or to another agency if they have a particular question. We get questions like, ‘Our incentive check for Meaningful Use came in thousands of dollars lower than what we anticipated — can you help us find out why?’ We’ve heard from people who haven’t received checks or are having trouble with attestation, and we’re able to use our presence in the DC area to help, and I’d love for more of members to know about that. When we can get input from our members, it makes us infinitely better at our jobs because we have the tales from the field. We’re not in a health system every day, so this helps us understand what we need to ask for and where we can help.
It’s common for people to question whether they can really make a difference, and I’ve told them that right now especially, policymakers are really interested in health IT. Sometimes that’s a benefit, and sometimes it’s a challenge, because everyone has ideas on how they can fix it, and it isn’t always the best perspective. So it’s a great time for us to be in this space and be willing to step forward and engage, because there is so much interest, and because we’re watching the health system evolve before our eyes. It’s definitely a challenge, but when we speak with folks, they’re always so appreciative, and it’s really humbling. They’re the ones who are saving lives and making healthcare better — we’re just their voice in Washington.